Healthcare Provider Details

I. General information

NPI: 1578995403
Provider Name (Legal Business Name): SMILE STRAIGHT ORTHODONTICS-AZ PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3552 W GLENDALE AVE
PHOENIX AZ
85051-8358
US

IV. Provider business mailing address

3552 W GLENDALE AVE
PHOENIX AZ
85051-8358
US

V. Phone/Fax

Practice location:
  • Phone: 602-888-7844
  • Fax: 602-841-0426
Mailing address:
  • Phone: 602-888-7844
  • Fax: 602-841-0426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD05860
License Number StateAZ

VIII. Authorized Official

Name: STEPHEN HUNSAKER
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 602-888-7844