Provider Demographics
NPI:1457100455
Name:SMILE STUDIO PLLC
Entity type:Organization
Organization Name:SMILE STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-694-8674
Mailing Address - Street 1:12075 N LUCKENBACH ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-3012
Mailing Address - Country:US
Mailing Address - Phone:623-694-8674
Mailing Address - Fax:
Practice Address - Street 1:3134 W CAREFREE HWY STE 9
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-4001
Practice Address - Country:US
Practice Address - Phone:623-335-9808
Practice Address - Fax:623-335-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty