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General NPI Number Information
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NPI Number | 1215008727
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Entity Type | Organization
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Legal Business Name | SMILE DENTAL GROUP
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6524 W INDIAN SCHOOL RD #1287
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City | PHOENIX
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State | AZ
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Zip | 85033
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Country | US
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Telephone | 623-846-5555
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Fax | 623-846-5619
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Provider Business Mailing Address
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Address Line | 6524 W INDIAN SCHOOL RD #1287
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City | PHOENIX
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State | AZ
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Zip | 85033
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Country | US
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Telephone | 623-846-5555
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Fax | 623-846-5619
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Authorized Official
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Title or Position | OWNER
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Name | DR. HEDAYAT HARSINI
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Credential | DDS
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Telephone | 602-996-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D5084
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License Number State | AZ
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