Provider Demographics
NPI:1609318005
Name:DR. SHEILA SMILES, PLLC
Entity Type:Organization
Organization Name:DR. SHEILA SMILES, PLLC
Other - Org Name:LODO ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOROUSHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-413-4828
Mailing Address - Street 1:8057 CHASEWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5605
Mailing Address - Country:US
Mailing Address - Phone:949-413-4828
Mailing Address - Fax:
Practice Address - Street 1:1499 BLAKE ST STE 1I
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1356
Practice Address - Country:US
Practice Address - Phone:303-872-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2020901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty