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General NPI Number Information
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NPI Number | 1518976216
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Entity Type | Organization
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Legal Business Name | GILBERT SMILES INC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1661 S VAL VISTA DR STE C 101
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City | GILBERT
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State | AZ
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Zip | 85296
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Country | US
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Telephone | 480-558-3100
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Fax | 480-855-9507
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Provider Business Mailing Address
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Address Line | 1661 S VAL VISTA DR STE C 101
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City | GILBERT
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State | AZ
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Zip | 85296
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Country | US
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Telephone | 480-558-3100
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Fax | 480-855-9507
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. JOHN KEITH SWAIN
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Credential | DMD
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Telephone | 480-558-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | AZ5267
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License Number State | AZ
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