Provider Demographics
NPI:1164607768
Name:SMILE SOLUTIONS LLC
Entity Type:Organization
Organization Name:SMILE SOLUTIONS LLC
Other - Org Name:CLEAR CHOICE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-225-0525
Mailing Address - Street 1:2617 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4705
Mailing Address - Country:US
Mailing Address - Phone:303-225-0525
Mailing Address - Fax:303-225-0526
Practice Address - Street 1:2617 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4705
Practice Address - Country:US
Practice Address - Phone:303-225-0525
Practice Address - Fax:303-225-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO82811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87656043Medicaid