Provider Demographics
NPI:1609904101
Name:AWESOME SMILES, P.C.
Entity Type:Organization
Organization Name:AWESOME SMILES, P.C.
Other - Org Name:AWESOME PEDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBIAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:DERLOSHON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-669-1122
Mailing Address - Street 1:2700 MADISON SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3385
Mailing Address - Country:US
Mailing Address - Phone:970-669-1122
Mailing Address - Fax:970-669-1984
Practice Address - Street 1:2700 MADISON SQUARE DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3385
Practice Address - Country:US
Practice Address - Phone:970-669-1122
Practice Address - Fax:970-669-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty