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General NPI Number Information
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NPI Number | 1902605710
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Entity Type | Organization
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Legal Business Name | DR SHEILA INNER SMILES, PLLC
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 791 W KELLY RD
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City | WOODLAND PARK
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State | CO
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Zip | 80863-3014
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Country | US
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Telephone | 719-687-6129
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Fax |
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Provider Business Mailing Address
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Address Line | 2575 MONTEBELLO DR W STE 101
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-6959
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHEILA SOROUSHIAN
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Credential |
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Telephone | 949-413-4828
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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 |
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License Number State |
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