Provider Demographics
NPI:1417382011
Name:SMILEY, RYAN NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NICOLE
Last Name:SMILEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 E BIJOU ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-8009
Mailing Address - Country:US
Mailing Address - Phone:719-576-8150
Mailing Address - Fax:719-955-3470
Practice Address - Street 1:1407 W 84TH AVE UNIT B8
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-4753
Practice Address - Country:US
Practice Address - Phone:720-214-4746
Practice Address - Fax:720-214-4745
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD38831223G0001X
KS614511223G0001X
CODEN.002020771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201206420AMedicaid
CO82004579Medicaid
NM25959239Medicaid