Provider Demographics
NPI:1952547838
Name:DELTA SMILES
Entity Type:Organization
Organization Name:DELTA SMILES
Other - Org Name:CORTEZ SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-560-9005
Mailing Address - Street 1:934 W 1500 S
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-2559
Mailing Address - Country:US
Mailing Address - Phone:970-560-9005
Mailing Address - Fax:
Practice Address - Street 1:437 S BLUFF ST
Practice Address - Street 2:STE 102
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3592
Practice Address - Country:US
Practice Address - Phone:435-688-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-26
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-94261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty