Provider Demographics
NPI:1083848857
Name:SMILE FOUR PROFESSIONALS LLC
Entity Type:Organization
Organization Name:SMILE FOUR PROFESSIONALS LLC
Other - Org Name:COMFORT DENTAL BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-565-2274
Mailing Address - Street 1:1221 S PUEBLO BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1507
Mailing Address - Country:US
Mailing Address - Phone:719-565-2274
Mailing Address - Fax:719-565-6829
Practice Address - Street 1:1221 S PUEBLO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-1507
Practice Address - Country:US
Practice Address - Phone:719-565-2274
Practice Address - Fax:719-565-6829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty