Provider Demographics
NPI:1952488710
Name:DRS OF SMILES PC
Entity Type:Organization
Organization Name:DRS OF SMILES PC
Other - Org Name:SCOTT LESUEUR AND CHARLES DODARO DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:LESUEUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-834-6991
Mailing Address - Street 1:1056 S VAL VISTA DR
Mailing Address - Street 2:STE 1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5625
Mailing Address - Country:US
Mailing Address - Phone:480-834-6991
Mailing Address - Fax:480-654-8836
Practice Address - Street 1:1056 S VAL VISTA DR
Practice Address - Street 2:STE 1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5625
Practice Address - Country:US
Practice Address - Phone:480-834-6991
Practice Address - Fax:480-654-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2695302F00000X
AZ3434302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3434OtherARIZONA MED LIC DENTAL
AZ2695OtherARIZONA MED LIC DENTAL