Provider Demographics
NPI:1215008727
Name:SMILE DENTAL GROUP
Entity Type:Organization
Organization Name:SMILE DENTAL GROUP
Other - Org Name:SCOTTSDALE CASVETRI DENTAL CARE INC NEW IMAGE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEDAYAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARSINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-996-8700
Mailing Address - Street 1:6524 W INDIAN SCHOOL RD #1287
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033
Mailing Address - Country:US
Mailing Address - Phone:623-846-5555
Mailing Address - Fax:623-846-5619
Practice Address - Street 1:6524 W INDIAN SCHOOL RD #1287
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033
Practice Address - Country:US
Practice Address - Phone:623-846-5555
Practice Address - Fax:623-846-5619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty