Provider Demographics
NPI:1811361751
Name:SIMPLE SMILES, PLLC
Entity Type:Organization
Organization Name:SIMPLE SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HUYEN
Authorized Official - Middle Name:THI THU
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-882-8887
Mailing Address - Street 1:14910 W EVANS PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-6463
Mailing Address - Country:US
Mailing Address - Phone:303-882-8887
Mailing Address - Fax:
Practice Address - Street 1:225 S SHERIDAN BLVD STE 114
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2405
Practice Address - Country:US
Practice Address - Phone:303-882-8887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98659227Medicaid