Healthcare Provider Details

I. General information

NPI: 1801733738
Provider Name (Legal Business Name): SMILES ONLY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 W ORANGE GROVE RD
TUCSON AZ
85741-3118
US

IV. Provider business mailing address

2165 W ORANGE GROVE RD
TUCSON AZ
85741-3118
US

V. Phone/Fax

Practice location:
  • Phone: 520-909-9999
  • Fax: 520-844-8634
Mailing address:
  • Phone: 520-909-9999
  • Fax: 520-844-8634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN DALE VREDENBURG III
Title or Position: OWNER
Credential:
Phone: 248-808-7109