Provider Demographics
NPI:1619090321
Name:ARCTIC SMILES ORTHODONTICS, PC
Entity Type:Organization
Organization Name:ARCTIC SMILES ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:480-614-2211
Mailing Address - Street 1:15029 N THOMPSON PEAK PKWY
Mailing Address - Street 2:SUITE B-119
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2217
Mailing Address - Country:US
Mailing Address - Phone:480-614-2211
Mailing Address - Fax:480-614-2233
Practice Address - Street 1:15029 N THOMPSON PEAK PKWY
Practice Address - Street 2:SUITE B-119
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2217
Practice Address - Country:US
Practice Address - Phone:480-614-2211
Practice Address - Fax:480-614-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ78611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty