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General NPI Number Information
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NPI Number | 1194956532
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Entity Type | Organization
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Legal Business Name | SMILE ENVY FAMILY DENTISTRY, L.L.C.
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Dates
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Enumeration Date | 08/03/2009
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Last Update Date | 08/03/2009
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Provider Practice Location Address
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Address Line | 10144 W LAKE PLEASANT PKWY SUITE 1100
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City | PEORIA
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State | AZ
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Zip | 85382-9716
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Country | US
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Telephone | 623-825-3689
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Fax | 623-825-3695
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Provider Business Mailing Address
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Address Line | 10144 W LAKE PLEASANT PKWY SUITE 1100
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City | PEORIA
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State | AZ
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Zip | 85382-9716
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Country | US
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Telephone | 623-825-3689
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Fax | 623-825-3695
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DIEDRA A IVEY
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Credential |
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Telephone | 623-825-3689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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