Provider Demographics
NPI:1285406728
Name:SMILE TWO, PROF. LLC
Entity type:Organization
Organization Name:SMILE TWO, PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-622-1225
Mailing Address - Street 1:3952 N ACADEMY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5910
Mailing Address - Country:US
Mailing Address - Phone:719-622-1225
Mailing Address - Fax:
Practice Address - Street 1:1221 S PUEBLO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-1507
Practice Address - Country:US
Practice Address - Phone:719-564-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMILE TWO, PROF. LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty