Provider Demographics
NPI:1417057332
Name:SMILES OF BEAUTY PC
Entity Type:Organization
Organization Name:SMILES OF BEAUTY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-551-6300
Mailing Address - Street 1:42104 N VENTURE DR
Mailing Address - Street 2:SUITE B134
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086
Mailing Address - Country:US
Mailing Address - Phone:623-551-6300
Mailing Address - Fax:623-551-6302
Practice Address - Street 1:42104 N VENTURE DR
Practice Address - Street 2:SUITE B134
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086
Practice Address - Country:US
Practice Address - Phone:623-551-6300
Practice Address - Fax:623-551-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty