Provider Demographics
NPI:1134607641
Name:COOMBS SMILE STUDIO, PC
Entity type:Organization
Organization Name:COOMBS SMILE STUDIO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-250-4301
Mailing Address - Street 1:8180 N HAYDEN RD STE D107
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2464
Mailing Address - Country:US
Mailing Address - Phone:480-250-4301
Mailing Address - Fax:480-935-6412
Practice Address - Street 1:8535 E HARTFORD DR STE 208
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5444
Practice Address - Country:US
Practice Address - Phone:480-420-4313
Practice Address - Fax:480-935-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ52171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty