Provider Demographics
NPI:1467817106
Name:SMILE TODAY PARADISE VALLEY, LLC
Entity Type:Organization
Organization Name:SMILE TODAY PARADISE VALLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-889-9457
Mailing Address - Street 1:4435 E HOLMES AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3372
Mailing Address - Country:US
Mailing Address - Phone:480-889-9457
Mailing Address - Fax:480-696-5505
Practice Address - Street 1:4530 E SHEA BLVD
Practice Address - Street 2:SUITE # 125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6065
Practice Address - Country:US
Practice Address - Phone:602-992-4530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty