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General NPI Number Information
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NPI Number | 1750515706
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Entity Type | Organization
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Legal Business Name | SMILE FOUR PROFESSIONALS LLC
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 4121 E COUNTY LINE RD
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City | CENTENNIAL
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State | CO
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Zip | 80122-8110
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Country | US
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Telephone | 303-220-0550
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Fax | 303-220-0553
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Provider Business Mailing Address
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Address Line | 4121 E COUNTY LINE RD
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City | CENTENNIAL
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State | CO
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Zip | 80122-8110
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Country | US
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Telephone | 303-220-0550
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Fax | 303-220-0553
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Authorized Official
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Title or Position | OWNER
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Name | DR. TANIA QUINN
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Credential | DMD
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Telephone | 303-220-0550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9576
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License Number State | CO
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