Basic Information
| Provider Information | |||||||||
| NPI: | 1124581665 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMBRACEKIDS V A PROFESSIONAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5865 E POWERS AVE | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801111545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034766233 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2250 S MONACO PKWY | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802225814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034766233 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2019 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | NIEBERG | ||||||||
| AuthorizedOfficialFirstName: | OWEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9172248171 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.