Provider Demographics
NPI:1730362054
Name:SMILE STUDIO ORTHODONTICS
Entity type:Organization
Organization Name:SMILE STUDIO ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-842-4544
Mailing Address - Street 1:10450 S. PROGRESS WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134
Mailing Address - Country:US
Mailing Address - Phone:720-780-0865
Mailing Address - Fax:
Practice Address - Street 1:10450 S. PROGRESS WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:720-780-0865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WATTS ORTHODONTICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-10
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO85301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty