Healthcare Provider Details

I. General information

NPI: 1215460233
Provider Name (Legal Business Name): ARIZONA SMILE DESIGN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13576 W CAMINO DEL SOL STE 18
SUN CITY WEST AZ
85375-4427
US

IV. Provider business mailing address

34225 N 27TH DRIVE #241
PHOENIX AZ
85085-6091
US

V. Phone/Fax

Practice location:
  • Phone: 623-474-3343
  • Fax:
Mailing address:
  • Phone: 623-439-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ADRIATIK RAMA
Title or Position: MANAGER
Credential: DDS
Phone: 623-474-3343