Provider Demographics
NPI:1790318608
Name:SMILE STRAIGHT ORTHODONTICS-CENTRAL MS PLLC
Entity Type:Organization
Organization Name:SMILE STRAIGHT ORTHODONTICS-CENTRAL MS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-866-8811
Mailing Address - Street 1:5717 E THOMAS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7620
Mailing Address - Country:US
Mailing Address - Phone:623-282-9959
Mailing Address - Fax:602-429-8200
Practice Address - Street 1:2300 N HILLS ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2633
Practice Address - Country:US
Practice Address - Phone:601-474-3140
Practice Address - Fax:601-474-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty