MEDICARE: BEAUTIFUL SMILEZ 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1588269542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL SMILEZ INC

Provider Business Mailing Address
First Line	:	1444 W BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-1624
Country	:	US
Telephone Number	:	602-633-6620
Fax Number	:	602-633-6625

Provider Business Practice Location Address
First Line	:	1444 W BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-1624
Country	:	US
Telephone Number	:	602-633-6620
Fax Number	:	602-633-6625

Authorized Official
Title or Position	:	REGIONAL
Name	:	MS. ELENA M ARMENDAREZ
Credential	:
Telephone Number	:	602-633-6620

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	01/21/2021

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Directions to “BEAUTIFUL SMILEZ INC ” Practice Location

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