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General NPI Number Information
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NPI Number | 1295033769
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Entity Type | Organization
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Legal Business Name | AN AMAZING SMILE, PLLC
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 8675 S PRIEST DR SUITE-101
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City | TEMPE
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State | AZ
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Zip | 85284-1914
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Country | US
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Telephone | 480-208-7436
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Fax | 866-316-7796
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Provider Business Mailing Address
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Address Line | PO BOX 2924
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City | SCOTTSDALE
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State | AZ
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Zip | 85252-2924
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Country | US
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Telephone | 480-208-7436
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Fax | 866-316-7796
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAHDI A ALI
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Credential | DMD, MPH
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Telephone | 480-208-7436
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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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