Provider Demographics
NPI:1851931828
Name:LASTING SMILES OF ANTHEM LLC
Entity Type:Organization
Organization Name:LASTING SMILES OF ANTHEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-551-8000
Mailing Address - Street 1:3618 W ANTHEM WAY STE D132
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0475
Mailing Address - Country:US
Mailing Address - Phone:623-551-8000
Mailing Address - Fax:623-465-4604
Practice Address - Street 1:3618 W ANTHEM WAY STE D132
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0475
Practice Address - Country:US
Practice Address - Phone:623-551-8000
Practice Address - Fax:623-465-4604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty