Provider Demographics
NPI:1801984208
Name:SURPRISE SMILES OF BEAUTY PC
Entity type:Organization
Organization Name:SURPRISE SMILES OF BEAUTY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-466-6322
Mailing Address - Street 1:15033 W BELL RD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:623-466-6322
Mailing Address - Fax:623-466-6325
Practice Address - Street 1:15033 W BELL RD
Practice Address - Street 2:SUITE 175
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-466-6322
Practice Address - Fax:623-466-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty