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General NPI Number Information
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NPI Number | 1144893728
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Entity Type | Organization
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Legal Business Name | SMILES OF GILBERT DENTAL LLC
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 7121 S VAL VISTA DR STE 103-104
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City | GILBERT
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State | AZ
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Zip | 85298-0064
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Country | US
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Telephone | 480-669-0195
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Fax |
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Provider Business Mailing Address
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Address Line | 7121 S VAL VISTA DR STE 103-104
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City | GILBERT
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State | AZ
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Zip | 85298-0064
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MAHMOOD BADRI
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Credential | DDS
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Telephone | 480-236-3621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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