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General NPI Number Information
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NPI Number | 1376099002
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Entity Type | Organization
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Legal Business Name | JESSICA LEE SMILES, LCC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 1220 W 38TH AVE
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City | DENVER
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State | CO
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Zip | 80211
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Country | US
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Telephone | 303-317-6990
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 W 38TH AVE
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City | DENVER
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State | CO
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Zip | 80211
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Country | US
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Telephone | 303-317-6990
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JESSICA MERVAU
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Credential | DDS
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Telephone | 269-908-1589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 00202605
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License Number State | CO
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