Organization
SMILES 4 KIDS 111 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN GEORGE WILSON DDS (OWNER)
(970) 249-8595
Entity
Organization
Contact information
Practice address
50 CHAMBER AVE, EAGLE, CO 81631
(970) 249-8595
Mailing address
1601 OXBOW DRIVE, SUITE 360 A, MONTROSE, CO 81401
(970) 249-8595
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
8632
CO
Other
Enumeration date
12/07/2009
Last updated
12/07/2009
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