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General NPI Number Information
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NPI Number | 1962167064
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Entity Type | Organization
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Legal Business Name | SELECT SMILES
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 2855 35TH AVE UNIT B
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City | GREELEY
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State | CO
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Zip | 80634-9474
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Country | US
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Telephone | 970-660-0925
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Fax |
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Provider Business Mailing Address
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Address Line | 6804 PUMPKIN RIDGE DR
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City | WINDSOR
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State | CO
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Zip | 80550-7016
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Country | US
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Telephone | 970-219-7307
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. BRADLEY W ECKHARDT
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Credential | DDS
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Telephone | 970-219-7307
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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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