Captain Smiles of Greeley PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CAPTAIN SMILES OF GREELEY PC

Practice address

3485 W 10TH St Ste C
Greeley, CO 80634-5368

Phone

(970) 353-4745

NPI assigned

Nov 23, 2020

Organization subpart

Yes

Parent organization

CAPTAIN SMILES OF GREELEY PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shaun Urbanozo

Title

Credentialing Manager

Phone

(719) 323-2362

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Adventure Dental, Vision and Orthodontics Doing business as

Tax ID family

Captain Smiles of Greeley PC2 organizations share this tax ID, including this one

Part of

Captain Smiles of Greeley PC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Captain Smiles of Greeley PC

  • General Practice Dentistry
  • Greeley, CO
  • NPI 1821299702
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Captain Smiles of Greeley PC

  • General Practice Dentistry
  • Greeley, CO
  • NPI 1821299702
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606089600000",
    "number": "1508460387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 E BIJOU ST STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809098009",
            "telephone_number": "719-576-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3485 W 10TH ST STE C",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806345368",
            "telephone_number": "970-353-4745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPTAIN SMILES OF GREELEY PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAPTAIN SMILES OF GREELEY PC",
        "enumeration_date": "2020-11-23",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-20",
        "status": "A",
        "authorized_official_last_name": "URBANOZO",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "719-323-2362"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35104074",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adventure Dental, Vision and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Richard M Campbell, D.O.
• Campus Clinics, LLC
• Campus Clinics, LLC
• Angelita Olivama Lavina Cantu
• Monica Canzona, RMT
• Captain Smiles of Greeley PC
• Cara Jones DDS Inc
• Cara Jones DDS LLC
• Talia Carbajal
• Zamir Carballo, DC

• General Practice Dentistry in Greeley, CO
• Providers in Greeley, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.