Provider Demographics
NPI:1962895904
Name:SMILE HIGH DENTAL HYGIENE, INC.
Entity type:Organization
Organization Name:SMILE HIGH DENTAL HYGIENE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HYGIENIST
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:303-955-8490
Mailing Address - Street 1:19751 E MAINSTREET
Mailing Address - Street 2:R08
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7378
Mailing Address - Country:US
Mailing Address - Phone:303-955-8490
Mailing Address - Fax:303-997-9359
Practice Address - Street 1:19751 E MAINSTREET
Practice Address - Street 2:R08
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7378
Practice Address - Country:US
Practice Address - Phone:303-955-8490
Practice Address - Fax:303-997-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH000903217261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental