# SMILES 4 KIDS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Smiles 4 Kids
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346516929
- **Authorized official:** DR. J RYAN MICKELSON (PRESIDENT)
- **Authorized official phone:** (970) 247-0174

## Contact information

- **Practice address:** 4337 E MAIN ST, STE 205, FARMINGTON, NM 87402-8633
- **Practice address phone:** (970) 247-0202
- **Mailing address:** 4337 E MAIN ST, STE 205, FARMINGTON, NM 87402-8633

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8630 | CO | Yes |

## Other

- **Enumeration date:** 03/28/2012
- **Last updated:** 03/28/2012