Provider Demographics
NPI:1609636034
Name:SMILE TRANSFORMATION CENTRE LLC
Entity Type:Organization
Organization Name:SMILE TRANSFORMATION CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GM
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-695-4192
Mailing Address - Street 1:16627 S LINDSAY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1501
Mailing Address - Country:US
Mailing Address - Phone:602-695-4192
Mailing Address - Fax:
Practice Address - Street 1:9980 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307-3005
Practice Address - Country:US
Practice Address - Phone:623-877-9501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty