MEDICARE: JUST SMILES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5090	AZ

General Provider Information

NPI Number	:	1245400183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUST SMILES, INC.

Provider Business Mailing Address
First Line	:	7054 E COCHISE RD
Second Line	:	B-215
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85253-4546
Country	:	US
Telephone Number	:	480-368-2222
Fax Number	:	480-369-6139

Provider Business Practice Location Address
First Line	:	7054 E COCHISE RD
Second Line	:	B-215
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85253-4546
Country	:	US
Telephone Number	:	480-368-2222
Fax Number	:	480-369-6139

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHEN BRIAN RESNICK
Credential	:	DMD
Telephone Number	:	480-368-2222

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	03/06/2008

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Directions to “JUST SMILES, INC. ” Practice Location

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