Provider Demographics
NPI:1053637769
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 1:2250 S MONACO PKWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5814
Mailing Address - Country:US
Mailing Address - Phone:303-476-6233
Mailing Address - Fax:720-351-4427
Practice Address - Street 1:2250 S MONACO PKWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5814
Practice Address - Country:US
Practice Address - Phone:303-476-6233
Practice Address - Fax:720-351-4427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68891223X0400X
CO92241223X0400X
CO92571223X0400X
CO76801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty