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Organization
SMILES 4 KIDS, LLC
Active
Organization
SMILES 4 KIDS, LLC
Active
Other names
Smiles 4 Kids
Organization subpart
No
Provider details
NPI number
Authorized official
DR. J RYAN MICKELSON (PRESIDENT)
(970) 247-0174
Entity
Organization
Contact information
Practice address
4337 E MAIN ST, STE 205, FARMINGTON, NM 87402-8633
(970) 247-0202
Mailing address
4337 E MAIN ST, STE 205, FARMINGTON, NM 87402-8633
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8630
CO
Other
Enumeration date
03/28/2012
Last updated
03/28/2012
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