Provider Demographics
NPI:1578345021
Name:JUST SMILES SCOTTSDALE, LLC
Entity Type:Organization
Organization Name:JUST SMILES SCOTTSDALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR CREDENTIALING TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:7054 E COCHISE RD STE B215
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-4552
Mailing Address - Country:US
Mailing Address - Phone:480-368-2222
Mailing Address - Fax:480-368-6139
Practice Address - Street 1:7054 E COCHISE RD STE B215
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4552
Practice Address - Country:US
Practice Address - Phone:480-368-2222
Practice Address - Fax:480-368-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty