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General NPI Number Information
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NPI Number | 1720210339
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Entity Type | Organization
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Legal Business Name | SMILE 4 LIFE, P.C.
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 12253 E 104TH PLACE SUITE 105
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City | COMMERCE CITY
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State | CO
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Zip | 80022
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Country | US
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Telephone | 303-853-8000
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Fax | 303-288-2219
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Provider Business Mailing Address
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Address Line | 12253 E 104TH PLACE SUITE 105
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City | COMMERCE CITY
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State | CO
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Zip | 80022
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Country | US
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Telephone | 303-853-8000
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Fax | 303-288-2219
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIE MACUMBER
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Credential | R.D.H.
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Telephone | 303-829-9243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 903823
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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