Provider Demographics
NPI:1073725115
Name:SMILE ZONE ORTHODONTICS
Entity Type:Organization
Organization Name:SMILE ZONE ORTHODONTICS
Other - Org Name:DR. JONATHAN WEINBACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WEINBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:303-430-4200
Mailing Address - Street 1:9910 WADSWORTH PKWY UNIT 300
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4295
Mailing Address - Country:US
Mailing Address - Phone:303-430-4200
Mailing Address - Fax:303-430-0863
Practice Address - Street 1:9910 WADSWORTH PKWY UNIT 300
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4295
Practice Address - Country:US
Practice Address - Phone:303-430-4200
Practice Address - Fax:303-430-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1053561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00673340Medicaid