Provider Demographics
NPI:1619212651
Name:MARICOPA SMILES DENTISTRY AND ORTHODONTICS, LLP
Entity Type:Organization
Organization Name:MARICOPA SMILES DENTISTRY AND ORTHODONTICS, LLP
Other - Org Name:MARICOPA SMILES DENTISTRY AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-568-2800
Mailing Address - Street 1:41620 W MARICOPA CASA GRANDE HWY STE 110
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-3217
Mailing Address - Country:US
Mailing Address - Phone:520-568-2800
Mailing Address - Fax:520-568-3087
Practice Address - Street 1:2860 MICHELLE FL 2
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-1008
Practice Address - Country:US
Practice Address - Phone:714-368-2077
Practice Address - Fax:714-508-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty