Provider Demographics
NPI:1932579448
Name:SMILE TODAY CHANDLER, PLC
Entity Type:Organization
Organization Name:SMILE TODAY CHANDLER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-640-0267
Mailing Address - Street 1:4425 N 24TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5513
Mailing Address - Country:US
Mailing Address - Phone:623-640-0267
Mailing Address - Fax:480-696-5505
Practice Address - Street 1:975 E RIGGS RD
Practice Address - Street 2:SUITE #8
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-4260
Practice Address - Country:US
Practice Address - Phone:480-895-3252
Practice Address - Fax:480-895-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0080701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty