Provider Demographics
NPI:1437394731
Name:SOUTHWESTERN SMILE DESIGN, LLC
Entity Type:Organization
Organization Name:SOUTHWESTERN SMILE DESIGN, LLC
Other - Org Name:MOUNTAIN VIEW DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:ELLINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-377-6185
Mailing Address - Street 1:18775 N REEMS RD
Mailing Address - Street 2:C-300
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8647
Mailing Address - Country:US
Mailing Address - Phone:623-584-3965
Mailing Address - Fax:623-584-0130
Practice Address - Street 1:18775 N REEMS RD
Practice Address - Street 2:C-300
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8647
Practice Address - Country:US
Practice Address - Phone:623-584-3965
Practice Address - Fax:623-584-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7229261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental