Provider Demographics
NPI:1295033769
Name:AN AMAZING SMILE, PLLC
Entity Type:Organization
Organization Name:AN AMAZING SMILE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:480-208-7436
Mailing Address - Street 1:PO BOX 2924
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-2924
Mailing Address - Country:US
Mailing Address - Phone:480-208-7436
Mailing Address - Fax:866-316-7796
Practice Address - Street 1:8675 S PRIEST DR
Practice Address - Street 2:SUITE-101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1914
Practice Address - Country:US
Practice Address - Phone:480-208-7436
Practice Address - Fax:866-316-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty