Provider Demographics
NPI:1083702484
Name:SMILES OF BEAUTY AT AVONDALE PC
Entity Type:Organization
Organization Name:SMILES OF BEAUTY AT AVONDALE PC
Other - Org Name:SMILES OF BEAUTY
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-474-2900
Mailing Address - Street 1:10750 W MCDOWELL RD
Mailing Address - Street 2:SUITE F610
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323
Mailing Address - Country:US
Mailing Address - Phone:623-474-2900
Mailing Address - Fax:623-474-2905
Practice Address - Street 1:10750 W MCDOWELL RD
Practice Address - Street 2:SUITE F610
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323
Practice Address - Country:US
Practice Address - Phone:623-474-2900
Practice Address - Fax:623-474-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty