Provider Demographics
NPI:1982215182
Name:ARIZONA SMIILE CENTER PLLC
Entity Type:Organization
Organization Name:ARIZONA SMIILE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLWINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-892-5089
Mailing Address - Street 1:2540 S SAN TAN VILLAGE PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0301
Mailing Address - Country:US
Mailing Address - Phone:480-892-5089
Mailing Address - Fax:480-237-9681
Practice Address - Street 1:2540 S SAN TAN VILLAGE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0301
Practice Address - Country:US
Practice Address - Phone:480-892-5089
Practice Address - Fax:480-237-9681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty