1982899712 NPI number — FAMILY SMILES

Table of content: (NPI 1982899712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982899712 NPI number — FAMILY SMILES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SMILES
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:
JAMES C. SWANSON, PC D. D. S., PC
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:
1982899712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 S PUEBLO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81005-1682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-564-0990
Provider Business Mailing Address Fax Number:
719-564-6817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 S PUEBLO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81005-1682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-564-0990
Provider Business Practice Location Address Fax Number:
719-564-6817
Provider Enumeration Date:
09/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SWANSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
719-564-0990

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  3700 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01734237 . This is a "JENNIFER KATTENSTELTE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 02073807 . This is a "JAMIE JOHNSON" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 81971842 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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