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General NPI Number Information
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NPI Number | 1215253992
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Entity Type | Organization
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Legal Business Name | AMAZING SMILES
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 7236 FEDERAL BLVD UNIT 100
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City | WESTMINSTER
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State | CO
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Zip | 80030-4965
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Country | US
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Telephone | 303-424-5439
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Fax | 303-427-5779
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Provider Business Mailing Address
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Address Line | 7236 FEDERAL BLVD UNIT 100
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City | WESTMINSTER
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State | CO
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Zip | 80030-4965
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Country | US
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Telephone | 303-424-5439
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Fax | 303-427-5779
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | AMY MELISSA JORGENSEN-BLACKBURN
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Credential |
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Telephone | 303-424-5439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 9230
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License Number State | CO
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