Provider Demographics
NPI:1740691344
Name:PEARLY WHITE SMILES
Entity type:Organization
Organization Name:PEARLY WHITE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:720-379-5465
Mailing Address - Street 1:8380 ZUNI ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-4689
Mailing Address - Country:US
Mailing Address - Phone:720-379-5465
Mailing Address - Fax:
Practice Address - Street 1:8380 ZUNI ST STE 205
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-4689
Practice Address - Country:US
Practice Address - Phone:720-379-5465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000906497124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty