Provider Demographics
NPI:1649162819
Name:MO SMILES LLC
Entity type:Organization
Organization Name:MO SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-582-4157
Mailing Address - Street 1:8461 TURNPIKE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-4379
Mailing Address - Country:US
Mailing Address - Phone:720-627-7734
Mailing Address - Fax:303-265-9247
Practice Address - Street 1:19420 N 59TH AVE STE C253
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6897
Practice Address - Country:US
Practice Address - Phone:623-934-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty