MEDICARE: SUMMIT SMILES PLLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1376256032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT SMILES PLLC

Provider Business Mailing Address
First Line	:	1700 N SALEM AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81001-2860
Country	:	US
Telephone Number	:	719-582-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 N SALEM AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81001-2860
Country	:	US
Telephone Number	:	719-582-4222
Fax Number	:	719-414-0027

Authorized Official
Title or Position	:	DIRECTOR OF RCM
Name	:	JENNY ORGANISTA
Credential	:
Telephone Number	:	917-966-0422

Provider Enumeration Date	:	12/27/2022
Last Update Date	:	04/09/2024

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Directions to “SUMMIT SMILES PLLC ” Practice Location

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