Provider Demographics
NPI:1154927994
Name:EMBRACEKIDS II, LLC
Entity type:Organization
Organization Name:EMBRACEKIDS II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-224-8171
Mailing Address - Street 1:901 E. 120TH AVE UNIT E
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233
Mailing Address - Country:US
Mailing Address - Phone:303-452-0077
Mailing Address - Fax:720-929-9967
Practice Address - Street 1:901 E. 120TH AVE UNIT E
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233
Practice Address - Country:US
Practice Address - Phone:303-452-0077
Practice Address - Fax:720-929-9967
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMBRACEKIDS II, LLC DBA: COLORADO ORTHODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty