Provider Demographics
NPI:1528770898
Name:KIDS SMILES DENTISTRY LLC
Entity type:Organization
Organization Name:KIDS SMILES DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RASOULI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-232-3095
Mailing Address - Street 1:1235 S DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1715
Mailing Address - Country:US
Mailing Address - Phone:720-232-3095
Mailing Address - Fax:
Practice Address - Street 1:1835 S FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-4953
Practice Address - Country:US
Practice Address - Phone:303-937-3750
Practice Address - Fax:303-935-5367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental