Provider Demographics
NPI:1518663848
Name:SMILE EIGHT PROFESSIONALS LLC
Entity Type:Organization
Organization Name:SMILE EIGHT PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DIEMER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-203-1821
Mailing Address - Street 1:2716 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-8443
Mailing Address - Country:US
Mailing Address - Phone:970-673-4310
Mailing Address - Fax:
Practice Address - Street 1:2716 11TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-8443
Practice Address - Country:US
Practice Address - Phone:970-673-4310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty