Healthcare Provider Details

I. General information

NPI: 1518976216
Provider Name (Legal Business Name): GILBERT SMILES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 S VAL VISTA DR STE C 101
GILBERT AZ
85296
US

IV. Provider business mailing address

1661 S VAL VISTA DR STE C 101
GILBERT AZ
85296
US

V. Phone/Fax

Practice location:
  • Phone: 480-558-3100
  • Fax: 480-855-9507
Mailing address:
  • Phone: 480-558-3100
  • Fax: 480-855-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberAZ5267
License Number StateAZ

VIII. Authorized Official

Name: DR. JOHN KEITH SWAIN
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 480-558-3100