Provider Demographics
NPI:1033643929
Name:PROSMILES ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:PROSMILES ORTHODONTICS, PLLC
Other - Org Name:PROSMILES ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:480-432-3363
Mailing Address - Street 1:3935 E ROUGH RIDER RD
Mailing Address - Street 2:1155
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-7346
Mailing Address - Country:US
Mailing Address - Phone:480-432-3363
Mailing Address - Fax:
Practice Address - Street 1:1981 N PEBBLE CREEK PKWY
Practice Address - Street 2:C01
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2543
Practice Address - Country:US
Practice Address - Phone:480-432-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ84041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty