# SMILES 4 KIDS 111 LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255660080
- **Authorized official:** BENJAMIN GEORGE WILSON DDS (OWNER)
- **Authorized official phone:** (970) 249-8595

## Contact information

- **Practice address:** 50 CHAMBER AVE, EAGLE, CO 81631
- **Practice address phone:** (970) 249-8595
- **Mailing address:** 1601 OXBOW DRIVE, SUITE 360 A, MONTROSE, CO 81401
- **Mailing address phone:** (970) 249-8595

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 8632 | CO | Yes |

## Other

- **Enumeration date:** 12/07/2009
- **Last updated:** 12/07/2009