Provider Demographics
NPI:1003132366
Name:EMBRACE KIDS, A PROFESSIONAL LLC
Entity Type:Organization
Organization Name:EMBRACE KIDS, A PROFESSIONAL LLC
Other - Org Name:ALL ABOUT BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-462-1462
Mailing Address - Street 1:2020 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 18-A
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5728
Mailing Address - Country:US
Mailing Address - Phone:303-462-1462
Mailing Address - Fax:303-997-5646
Practice Address - Street 1:15159 E COLFAX AVE
Practice Address - Street 2:UNIT B
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-5705
Practice Address - Country:US
Practice Address - Phone:303-341-5437
Practice Address - Fax:303-341-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68891223X0400X
CO92241223X0400X
CO92571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty