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General NPI Number Information
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NPI Number | 1255012621
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Entity Type | Organization
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Legal Business Name | NAVAJO SMILES LLC
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Dates
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Enumeration Date | 07/28/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 10140 W LAKE PLEASANT PKWY STE 1220
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City | PEORIA
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State | AZ
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Zip | 85382-9718
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Country | US
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Telephone | 623-295-2005
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Fax | 623-321-4224
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Provider Business Mailing Address
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Address Line | 10140 W LAKE PLEASANT PKWY STE 1220
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City | PEORIA
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State | AZ
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Zip | 85382-9718
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Country | US
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Telephone | 623-295-2005
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Fax | 623-321-4224
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Authorized Official
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Title or Position | OWNER
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Name | CHAD LYONS
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Credential | DDS
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Telephone | 623-295-2005
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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 |
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License Number State |
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