Healthcare Provider Details

I. General information

NPI: 1265147672
Provider Name (Legal Business Name): SMILES FOR SPECIAL NEEDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 E SOUTHERN AVE
MESA AZ
85204-5409
US

IV. Provider business mailing address

2424 E SOUTHERN AVE
MESA AZ
85204-5409
US

V. Phone/Fax

Practice location:
  • Phone: 602-931-9405
  • Fax:
Mailing address:
  • Phone: 602-931-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOSEPH LAWRENCE HUGHES
Title or Position: OWNER
Credential:
Phone: 480-361-1972