MEDICARE: SMILE STRAIGHT ORTHODONTICS - GREENWAY LLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1881169233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE STRAIGHT ORTHODONTICS - GREENWAY LLC

Provider Business Mailing Address
First Line	:	3229 E GREENWAY RD STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4508
Country	:	US
Telephone Number	:	623-215-9699
Fax Number	:

Provider Business Practice Location Address
First Line	:	3229 E GREENWAY RD STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4508
Country	:	US
Telephone Number	:	623-215-9699
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	TERESA ZWICKY
Credential	:
Telephone Number	:	480-866-8811

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	08/20/2025

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