Provider Demographics
NPI:1699021329
Name:FOREVER SMILES LLC
Entity Type:Organization
Organization Name:FOREVER SMILES LLC
Other - Org Name:FOREVER SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-258-2823
Mailing Address - Street 1:13402 N 32ND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-6047
Mailing Address - Country:US
Mailing Address - Phone:480-258-2823
Mailing Address - Fax:
Practice Address - Street 1:13402 N 32ND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-6047
Practice Address - Country:US
Practice Address - Phone:480-258-2823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD04075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1164620597OtherNPI