Provider Demographics
NPI:1376256032
Name:SUMMIT SMILES PLLC
Entity Type:Organization
Organization Name:SUMMIT SMILES PLLC
Other - Org Name:PRESTIGE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORGANISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-966-0422
Mailing Address - Street 1:1700 N SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-2860
Mailing Address - Country:US
Mailing Address - Phone:719-582-4222
Mailing Address - Fax:
Practice Address - Street 1:1700 N SALEM AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-2860
Practice Address - Country:US
Practice Address - Phone:719-582-4222
Practice Address - Fax:719-414-0027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT SMILES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-27
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty