Provider Demographics
NPI:1225687825
Name:LAVEEN SMILES PLLC
Entity Type:Organization
Organization Name:LAVEEN SMILES PLLC
Other - Org Name:LAVEEN SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:TYNDAL
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-603-5446
Mailing Address - Street 1:7205 S 51ST AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7399
Mailing Address - Country:US
Mailing Address - Phone:602-603-5446
Mailing Address - Fax:
Practice Address - Street 1:7205 S 51ST AVE STE 104
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7399
Practice Address - Country:US
Practice Address - Phone:602-603-5446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental