Organization
SMILES FOR COLORADO ORTHODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BANGORN S TERRY M.S., D.M.D. (OWNER)
(719) 227-7645
Entity
Organization
Contact information
Practice address
1539 S 8TH ST STE 200, COLORADO SPRINGS, CO 80906-1977
(719) 227-7645
Mailing address
8115 NIGHT BLUFF DR, SAN ANTONIO, TX 78255-3300
(210) 264-3102
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99488361
—
CO
Enumeration date
05/30/2008
Last updated
05/30/2008
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