Provider Demographics
NPI:1003205444
Name:SMILE TODAY GILBERT
Entity Type:Organization
Organization Name:SMILE TODAY GILBERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-994-9494
Mailing Address - Street 1:2487 S. GILBERT RD
Mailing Address - Street 2:#105
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2802
Mailing Address - Country:US
Mailing Address - Phone:480-994-9494
Mailing Address - Fax:480-949-8395
Practice Address - Street 1:2487 S GILBERT RD
Practice Address - Street 2:#105
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8899
Practice Address - Country:US
Practice Address - Phone:480-994-9494
Practice Address - Fax:480-949-8395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMILE TODAY KEYSTONE DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD80701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty