Provider Demographics
NPI:1245408020
Name:SMILES OF AMERICA, PLLC/CHANDLER
Entity Type:Organization
Organization Name:SMILES OF AMERICA, PLLC/CHANDLER
Other - Org Name:SMILES OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-812-2080
Mailing Address - Street 1:155 E RAY RD
Mailing Address - Street 2:STE #4
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-3303
Mailing Address - Country:US
Mailing Address - Phone:480-812-2636
Mailing Address - Fax:480-812-1149
Practice Address - Street 1:155 E RAY RD
Practice Address - Street 2:STE #4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3303
Practice Address - Country:US
Practice Address - Phone:480-812-2636
Practice Address - Fax:480-812-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization