MEDICARE: SMILE TWO PROFESSIONALS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1366011751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE TWO PROFESSIONALS

Provider Business Mailing Address
First Line	:	1580 SPACE CENTER DR STE A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-2445
Country	:	US
Telephone Number	:	719-622-1225
Fax Number	:

Provider Business Practice Location Address
First Line	:	1580 SPACE CENTER DR STE A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-2445
Country	:	US
Telephone Number	:	719-622-1225
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TANIA QUINN
Credential	:	DMD
Telephone Number	:	719-622-1225

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	06/21/2021

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Directions to “SMILE TWO PROFESSIONALS ” Practice Location

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