Provider Demographics
NPI:1255012621
Name:NAVAJO SMILES LLC
Entity type:Organization
Organization Name:NAVAJO SMILES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-295-2005
Mailing Address - Street 1:10140 W LAKE PLEASANT PKWY STE 1220
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9718
Mailing Address - Country:US
Mailing Address - Phone:623-295-2005
Mailing Address - Fax:623-321-4224
Practice Address - Street 1:10140 W LAKE PLEASANT PKWY STE 1220
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9718
Practice Address - Country:US
Practice Address - Phone:623-295-2005
Practice Address - Fax:623-321-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty