Provider Demographics
NPI:1508354739
Name:USMILE MOBILE DENTAL GROUP
Entity Type:Organization
Organization Name:USMILE MOBILE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:V
Authorized Official - Last Name:SKORMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-500-2053
Mailing Address - Street 1:9801 E COLFAX AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-2155
Mailing Address - Country:US
Mailing Address - Phone:720-500-2053
Mailing Address - Fax:
Practice Address - Street 1:9801 E COLFAX AVE
Practice Address - Street 2:UNIT 120
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010
Practice Address - Country:US
Practice Address - Phone:720-500-2053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX288571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty