5TH AVE SMILE LLC — NPI 1144742628 (Licensed & Credentialed Dental Hygienist in AURORA, CO)

CMS-1500 Box 24J / 33a • NPI

1144742628

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

124Q00000X

Licensed & Credentialed Dental Hygienist

Box 32 Service Location & ZIP+4

2044 CLINTON ST UNIT B, AURORA, CO, 80010-1003

✓ 9-Digit EDI 837 ZIP+4 (80010-1003)

Practice Phone & Referral Fax

(303) 360-7462

Fax: (303) 360-7475

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1144742628 (5TH AVE SMILE LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1144742628` (NPI-2 Organization / Facility)
Provider / Legal Name	5TH AVE SMILE LLC
Plain-English Specialty	Licensed & Credentialed Dental Hygienist NUCC Code: `124Q00000X` (Dental Hygienist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2044 CLINTON ST UNIT B, AURORA, CO, 80010-1003
Practice Telephone / Fax	Tel: (303) 360-7462 \| Fax: (303) 360-7475
Administrative Mailing Address	2044 CLINTON ST UNIT B, AURORA, CO, 80010-1003
Enumeration & Last Sync	Enumerated: 2017-07-17 \| CMS Record Updated: 2022-07-21
Authorized Official	JUSTICE OSEI TUTU (Dental Hygienist)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2044 CLINTON ST UNIT B, AURORA, CO, 80010-1003

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Plain-English Taxonomy & CMS Crosswalk (124Q00000X)

What Does Taxonomy Code 124Q00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 124Q00000X translates to:
"Licensed & Credentialed Dental Hygienist"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Dental Hygienist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (5TH AVE SMILE LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`124Q00000X` — Dental Hygienist Plain English: Licensed & Credentialed Dental Hygienist	State: CO \| License: `DH.002024345` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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5TH AVE SMILE LLC (NPI #1144742628)