Provider Demographics
NPI:1902023930
Name:SMILE DENTAL GROUP
Entity Type:Organization
Organization Name:SMILE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEDAYAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARSINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-846-5555
Mailing Address - Street 1:122 SKYVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823
Mailing Address - Country:US
Mailing Address - Phone:814-355-2945
Mailing Address - Fax:
Practice Address - Street 1:6524 W INDIAN SCHOOL ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033
Practice Address - Country:US
Practice Address - Phone:623-846-5555
Practice Address - Fax:623-846-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty