Provider Demographics
NPI:1437968716
Name:CEDAR SMILES LLC
Entity type:Organization
Organization Name:CEDAR SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:KOFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-331-2504
Mailing Address - Street 1:1751 W ROYAL HUNTE DR STE B
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-1865
Mailing Address - Country:US
Mailing Address - Phone:435-865-9111
Mailing Address - Fax:
Practice Address - Street 1:1751 W ROYAL HUNTE DR STE B
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-1865
Practice Address - Country:US
Practice Address - Phone:435-865-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty