Provider Demographics
NPI:1477219418
Name:SMILE STRAIGHT ORTHODONTICS-CENTRAL MS PLLC
Entity Type:Organization
Organization Name:SMILE STRAIGHT ORTHODONTICS-CENTRAL MS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRED MGR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:ZWICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-866-8811
Mailing Address - Street 1:5717 E THOMAS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7040 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1035
Practice Address - Country:US
Practice Address - Phone:601-368-6635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty