Provider Demographics
NPI:1922575018
Name:MARICOPA SMILES, LLC
Entity Type:Organization
Organization Name:MARICOPA SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:833-793-7773
Mailing Address - Street 1:20917 N JOHN WAYNE PKWY STE A105
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-2918
Mailing Address - Country:US
Mailing Address - Phone:833-793-7773
Mailing Address - Fax:520-442-1488
Practice Address - Street 1:20917 N JOHN WAYNE PKWY STE A105
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2918
Practice Address - Country:US
Practice Address - Phone:833-793-7773
Practice Address - Fax:520-442-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental