Provider Demographics
NPI:1366011751
Name:SMILE TWO PROFESSIONALS
Entity Type:Organization
Organization Name:SMILE TWO PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-622-1225
Mailing Address - Street 1:1580 SPACE CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-2445
Mailing Address - Country:US
Mailing Address - Phone:719-622-1225
Mailing Address - Fax:
Practice Address - Street 1:1580 SPACE CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-2445
Practice Address - Country:US
Practice Address - Phone:719-622-1225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMILE TWO PROFESSIONALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty