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General NPI Number Information
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NPI Number | 1235536046
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Entity Type | Organization
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Legal Business Name | SMILECARE
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 10521 S PARKER RD STE E
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City | PARKER
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State | CO
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Zip | 80134-9079
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Country | US
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Telephone | 719-287-0807
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Fax |
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Provider Business Mailing Address
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Address Line | 10521 S PARKER RD STE E
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City | PARKER
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State | CO
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Zip | 80134-9079
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIKASH KANCHANLAL
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Credential | D.M.D
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Telephone | 719-287-0807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8392
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License Number State | CO
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