Healthcare Provider Details

I. General information

NPI: 1881338283
Provider Name (Legal Business Name): DP SMILES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 S VAL VISTA DR STE C-101
GILBERT AZ
85295-4508
US

IV. Provider business mailing address

185 S 163RD ST
GILBERT AZ
85296-9475
US

V. Phone/Fax

Practice location:
  • Phone: 480-558-3100
  • Fax:
Mailing address:
  • Phone: 480-203-6415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID POELMAN
Title or Position: OWNER
Credential: DDS
Phone: 480-203-6415