Provider Demographics
NPI:1518302496
Name:SMILE TODAY THUNDERBIRD PLC
Entity Type:Organization
Organization Name:SMILE TODAY THUNDERBIRD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-616-1562
Mailing Address - Street 1:1820 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6300
Mailing Address - Country:US
Mailing Address - Phone:602-616-1562
Mailing Address - Fax:
Practice Address - Street 1:1820 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6300
Practice Address - Country:US
Practice Address - Phone:602-616-1562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEYSTONE DENTAL PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty