| Smile Bar Llc | |
|
1752 28th Ave Greeley CO 80634-5715 | |
| (303) 808-7722 | |
| Not Available |
| Full Name | Smile Bar Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1752 28th Ave, Greeley, Colorado |
| Authorized Official Name and Position | Tara Marie Bonneau (CEO) |
| Authorized Official Contact | 3038087722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Smile Bar Llc 1752 28th Ave Greeley CO 80634-5715 Ph: (303) 808-7722 | Smile Bar Llc 1752 28th Ave Greeley CO 80634-5715 Ph: (303) 808-7722 |
| NPI Number | 1467291559 |
|---|---|
| Provider Enumeration Date | 05/20/2024 |
| Last Update Date | 05/20/2024 |
| Medicare PECOS PAC ID | 0143764662 |
|---|---|
| Medicare Enrollment ID | O20240626000071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467291559 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Tara Marie Bonneau |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1124873443 PECOS PAC ID: 1052855574 Enrollment ID: I20240626000265 |
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