Provider Demographics
NPI:1174858294
Name:SMILE SIX PROFESSIONALS LLC
Entity Type:Organization
Organization Name:SMILE SIX 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:CARL
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BAHR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-252-4050
Mailing Address - Street 1:9652 N WASHINGTON ST
Mailing Address - Street 2:9652 N WASHINGTON ST
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2160
Mailing Address - Country:US
Mailing Address - Phone:303-252-4050
Mailing Address - Fax:303-252-4052
Practice Address - Street 1:9652 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229
Practice Address - Country:US
Practice Address - Phone:303-252-4050
Practice Address - Fax:303-252-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty