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General NPI Number Information
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NPI Number | 1427491802
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Entity Type | Organization
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Legal Business Name | LAKEWOOD SMILES, P.C.
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 10815 W JEWELL AVE STE L
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City | LAKEWOOD
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State | CO
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Zip | 80232-6268
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Country | US
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Telephone | 303-988-6860
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Fax | 303-988-3274
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Provider Business Mailing Address
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Address Line | 10815 W JEWELL AVE
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City | LAKEWOOD
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State | CO
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Zip | 80232-4851
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Country | US
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Telephone | 303-988-6860
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Fax | 303-988-3274
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Authorized Official
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Title or Position | OWNER
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Name | SAUL ESCALA
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Credential | DDS
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Telephone | 303-988-6860
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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 | DEN9509
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License Number State | CO
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