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General NPI Number Information
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NPI Number | 1467291559
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Entity Type | Organization
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Legal Business Name | SMILE BAR LLC
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 1752 28TH AVE
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City | GREELEY
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State | CO
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Zip | 80634-5715
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Country | US
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Telephone | 303-808-7722
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Fax |
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Provider Business Mailing Address
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Address Line | 1752 28TH AVE
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City | GREELEY
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State | CO
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Zip | 80634-5715
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Country | US
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Telephone | 303-808-7722
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISS TARA MARIE BONNEAU
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Credential | RDH, BS, MBA
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Telephone | 303-808-7722
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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 |
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License Number State |
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