Organization
ALLIANCE DENTAL GROUP
Active
Other names
Smile 4 Life Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIE MACUMBER (MEMBER/MANAGER)
(303) 829-9243
Entity
Organization
Contact information
Practice address
12253 E 104TH PL UNIT 105, COMMERCE CITY, CO 80022-2096
(303) 853-8000
(303) 288-2219
Mailing address
12253 E 104TH PL UNIT 105, COMMERCE CITY, CO 80022-2096
(303) 853-8000
(303) 288-2219
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN00202825
CO
124Q00000X
Dental Hygienist
DH.000903823
CO
Other
Enumeration date
09/04/2018
Last updated
09/04/2018
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