1538296892 NPI number — EMBRACEABLE LLC

Table of content: (NPI 1538296892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538296892 NPI number — EMBRACEABLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMBRACEABLE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMFORT DENTAL BRACES GLENWOOD SPRINGS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538296892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13980 W EXPOSITION PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80228-2344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-985-3686
Provider Business Mailing Address Fax Number:
303-985-3011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1512 GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
GLENWOOD SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81601-3861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-945-2588
Provider Business Practice Location Address Fax Number:
970-928-0741
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLOSS
Authorized Official First Name:
CLAUDE
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PARTNER OWNER
Authorized Official Telephone Number:
303-985-3686

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  105444 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X , with the licence number: 00280 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: 8637 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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