Healthcare Provider Details

I. General information

NPI: 1043905839
Provider Name (Legal Business Name): STEPHANIE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7342 E THOMAS RD STE 100
SCOTTSDALE AZ
85251-7243
US

IV. Provider business mailing address

7501 E MCDOWELL RD APT 2211
SCOTTSDALE AZ
85257-3569
US

V. Phone/Fax

Practice location:
  • Phone: 480-935-2424
  • Fax:
Mailing address:
  • Phone: 860-808-6829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012117
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: