Provider Demographics
NPI:1417134560
Name:MOBILE SMILES INC
Entity Type:Organization
Organization Name:MOBILE SMILES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KURTAK
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:520-904-2211
Mailing Address - Street 1:3419 N GERONIMO AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-3611
Mailing Address - Country:US
Mailing Address - Phone:520-904-2211
Mailing Address - Fax:
Practice Address - Street 1:3419 N GERONIMO AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3611
Practice Address - Country:US
Practice Address - Phone:520-904-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5035124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty