=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215194469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMILE CONCEPTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2008
-----------------------------------------------------
Last Update Date | 05/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13402 N SCOTTSDALE RD SUITE A110
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-4054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-951-2800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13402 N SCOTTSDALE ROAD SUITE A110
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-951-2800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PARVATI H. IYER
-----------------------------------------------------
Credential | D.D.S.,
-----------------------------------------------------
Telephone | 480-951-2800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 5106
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------