Provider Demographics
NPI:1124571617
Name:SMILE ROCKERS, PLLC
Entity Type:Organization
Organization Name:SMILE ROCKERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CACKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:BSDH, RDH
Authorized Official - Phone:303-952-9796
Mailing Address - Street 1:4955 W. 72ND AVE., UNIT L1
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80030-5146
Mailing Address - Country:US
Mailing Address - Phone:303-952-9796
Mailing Address - Fax:
Practice Address - Street 1:4955 W 72ND AVE UNIT L1
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-5146
Practice Address - Country:US
Practice Address - Phone:630-750-1429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000906409261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental