Provider Demographics
NPI:1043816093
Name:RADIANCE SMILE SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:RADIANCE SMILE SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RADIP
Authorized Official - Middle Name:
Authorized Official - Last Name:UPRETY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-226-0695
Mailing Address - Street 1:355 ELDORADO BLVD UNIT 341
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3689
Mailing Address - Country:US
Mailing Address - Phone:612-226-0695
Mailing Address - Fax:
Practice Address - Street 1:350 BROADWAY ST STE 140
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-3306
Practice Address - Country:US
Practice Address - Phone:303-447-2281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental