MEDICARE: SMILE DOCTORS OF COLORADO, P.C.

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	:	1861235368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE DOCTORS OF COLORADO, P.C.

Provider Business Mailing Address
First Line	:	5400 LBJ FWY STE 800
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-1058
Country	:	US
Telephone Number	:	719-252-1860
Fax Number	:

Provider Business Practice Location Address
First Line	:	6620 CAMDEN BLVD
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-2505
Country	:	US
Telephone Number	:	719-631-6649
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT V. LAW
Credential	:	DMD
Telephone Number	:	719-569-5715

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	06/13/2024

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