Provider Demographics
NPI:1407478159
Name:COLORADO COMFORT SMILES PROF LLC
Entity Type:Organization
Organization Name:COLORADO COMFORT SMILES PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRIJALVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-341-2273
Mailing Address - Street 1:354 BLUE RIVER PARKWAY
Mailing Address - Street 2:A
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498
Mailing Address - Country:US
Mailing Address - Phone:303-341-2273
Mailing Address - Fax:303-344-2286
Practice Address - Street 1:354 BLUE RIVER PARKWAY
Practice Address - Street 2:A
Practice Address - City:SILVERTHORNE
Practice Address - State:CO
Practice Address - Zip Code:80498
Practice Address - Country:US
Practice Address - Phone:303-341-2273
Practice Address - Fax:303-344-2286
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO COMFORT SMILES PROF LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty