Provider Demographics
NPI:1174167217
Name:MOUNTAIN SMILES, PLLC
Entity type:Organization
Organization Name:MOUNTAIN SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-951-9153
Mailing Address - Street 1:1801 WEWATTA ST FL 11
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-6318
Mailing Address - Country:US
Mailing Address - Phone:417-861-9740
Mailing Address - Fax:
Practice Address - Street 1:6665 DELMONICO DR STE C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1895
Practice Address - Country:US
Practice Address - Phone:719-599-5700
Practice Address - Fax:719-414-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty