Provider Demographics
NPI:1417366790
Name:FRONT RANGE SMILES, PLLC
Entity Type:Organization
Organization Name:FRONT RANGE SMILES, PLLC
Other - Org Name:SPRINGS YOUTH DENTISTRY, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:CEJKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-666-1162
Mailing Address - Street 1:11223 JANSEN ST.
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134
Mailing Address - Country:US
Mailing Address - Phone:720-666-1162
Mailing Address - Fax:720-222-5169
Practice Address - Street 1:8870 N SUNDOWN TRL
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:720-666-1162
Practice Address - Fax:720-222-5169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10762261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental