Organization · NPI-2

5th Ave Smile LLC

Dental Hygienist · Aurora, CO

NPI number1144742628
StatusActive
Last updated in NPPESJul 21, 2022

Details

NPI
1144742628
Entity type
Organization (NPI-2)
Legal business name
5th Ave Smile LLC
Organization subpart
No
Enumeration date
Jul 17, 2017
Last updated
Jul 21, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
124Q00000X Dental HygienistDH.002024345COYes

Practice location

2044 Clinton St Unit B
Aurora, CO 80010-1003

Phone 303-360-7462 · Fax 303-360-7475

Mailing address

2044 Clinton St Unit B
Aurora, CO 80010-1003

Phone 303-360-7462 · Fax 303-360-7475

Authorized official

Justice Osei Tutu
Dental Hygienist
3033607462

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