Provider Demographics
NPI:1669016218
Name:SMILE 24 DENTISTRY, LLC
Entity Type:Organization
Organization Name:SMILE 24 DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VITANOV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-675-0896
Mailing Address - Street 1:2701 E CAMELBACK RD STE 165
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4330
Mailing Address - Country:US
Mailing Address - Phone:602-675-0896
Mailing Address - Fax:602-825-1209
Practice Address - Street 1:2701 E CAMELBACK RD STE 165
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4330
Practice Address - Country:US
Practice Address - Phone:602-675-0896
Practice Address - Fax:602-825-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental