Organization
SPARKLING SMILES MOBILE DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KASSIDEE N FICKEN (RDH)
(970) 630-4226
Entity
Organization
Contact information
Practice address
6671 US HWY 36, JOES, CO 80822
(970) 630-4226
Mailing address
7525 COUNTY ROAD M, KIRK, CO 80824-9759
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
—
Other
Enumeration date
11/09/2020
Last updated
11/20/2020
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