Provider Demographics
NPI:1457083867
Name:SMILE SCIENCE, PLLC
Entity Type:Organization
Organization Name:SMILE SCIENCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:385-228-9747
Mailing Address - Street 1:20118 N 67TH AVE # C308
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4621
Mailing Address - Country:US
Mailing Address - Phone:480-530-3663
Mailing Address - Fax:480-530-3536
Practice Address - Street 1:20118 N 67TH AVE # C308
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4621
Practice Address - Country:US
Practice Address - Phone:480-530-3663
Practice Address - Fax:480-530-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007830Medicaid