Healthcare Provider Details

I. General information

NPI: 1841751054
Provider Name (Legal Business Name): I SMILE AT PEARCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 N FRONTAGE ROAD
PEARCE AZ
85625-7509
US

IV. Provider business mailing address

11550 E IRVINGTON RD
TUCSON AZ
85747-8925
US

V. Phone/Fax

Practice location:
  • Phone: 520-826-3444
  • Fax: 520-391-5606
Mailing address:
  • Phone: 520-779-5940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ROXANNE CRAWFORD
Title or Position: CAO
Credential:
Phone: 520-779-5940