Provider Demographics
NPI:1205375946
Name:MOBILE SMILES LLC
Entity Type:Organization
Organization Name:MOBILE SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DOLORES
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:719-351-0524
Mailing Address - Street 1:2510 ANTIETAM LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1403
Mailing Address - Country:US
Mailing Address - Phone:719-351-0524
Mailing Address - Fax:
Practice Address - Street 1:2510 ANTIETAM LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1403
Practice Address - Country:US
Practice Address - Phone:719-351-0524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2638124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty