Provider Demographics
NPI:1013800879
Name:HIGH SMILEAGE DENTAL LLC
Entity type:Organization
Organization Name:HIGH SMILEAGE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:FU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-200-5596
Mailing Address - Street 1:1404 W CHEYENNE RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3019
Mailing Address - Country:US
Mailing Address - Phone:909-200-5596
Mailing Address - Fax:
Practice Address - Street 1:1404 W CHEYENNE RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3019
Practice Address - Country:US
Practice Address - Phone:909-200-5596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental