Provider Demographics
NPI:1578995403
Name:SMILE STRAIGHT ORTHODONTICS-AZ PLLC
Entity Type:Organization
Organization Name:SMILE STRAIGHT ORTHODONTICS-AZ PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNSAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-888-7844
Mailing Address - Street 1:3552 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-8358
Mailing Address - Country:US
Mailing Address - Phone:602-888-7844
Mailing Address - Fax:602-841-0426
Practice Address - Street 1:3552 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8358
Practice Address - Country:US
Practice Address - Phone:602-888-7844
Practice Address - Fax:602-841-0426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD058601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty