Provider Demographics
NPI:1194350892
Name:KIDZ & FAMILY SMILES, PLLC
Entity type:Organization
Organization Name:KIDZ & FAMILY SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-821-1240
Mailing Address - Street 1:12 PURDUE ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2018
Mailing Address - Country:US
Mailing Address - Phone:719-821-1240
Mailing Address - Fax:
Practice Address - Street 1:214 SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1524
Practice Address - Country:US
Practice Address - Phone:719-821-1240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty