Provider Demographics
NPI:1720210339
Name:SMILE 4 LIFE, P.C.
Entity Type:Organization
Organization Name:SMILE 4 LIFE, P.C.
Other - Org Name:SMILE 4 LIFE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACUMBER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:303-829-9243
Mailing Address - Street 1:12253 E 104TH PLACE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022
Mailing Address - Country:US
Mailing Address - Phone:303-853-8000
Mailing Address - Fax:303-288-2219
Practice Address - Street 1:12253 E 104TH PLACE
Practice Address - Street 2:SUITE 105
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022
Practice Address - Country:US
Practice Address - Phone:303-853-8000
Practice Address - Fax:303-288-2219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMILE 4 LIFE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-14
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
CO903823124Q00000X
CODE-9897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty