Provider Demographics
NPI:1063035863
Name:MOUNTAIN SMILES, PLLC
Entity Type:Organization
Organization Name:MOUNTAIN SMILES, PLLC
Other - Org Name:TUTTLE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYDIATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-861-9740
Mailing Address - Street 1:6240 WOODMEN PARK VW
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2616
Mailing Address - Country:US
Mailing Address - Phone:719-282-6636
Mailing Address - Fax:719-282-6646
Practice Address - Street 1:6240 WOODMEN PARK VW
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2616
Practice Address - Country:US
Practice Address - Phone:719-282-6636
Practice Address - Fax:719-282-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty