Provider Demographics
NPI:1467215822
Name:CAREFREE SMILES DESIGN STUDIO
Entity Type:Organization
Organization Name:CAREFREE SMILES DESIGN STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DESTRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-859-5953
Mailing Address - Street 1:2525 W CAREFREE HWY STE 152
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6097
Mailing Address - Country:US
Mailing Address - Phone:602-859-5953
Mailing Address - Fax:
Practice Address - Street 1:2525 W CAREFREE HWY STE 152
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6097
Practice Address - Country:US
Practice Address - Phone:602-859-5953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty