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General NPI Number Information
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NPI Number | 1619212651
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Entity Type | Organization
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Legal Business Name | MARICOPA SMILES DENTISTRY AND ORTHODONTICS, LLP
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 2860 MICHELLE FL 2
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City | IRVINE
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State | CA
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Zip | 92606-1008
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Country | US
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Telephone | 714-368-2077
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Fax | 714-508-6400
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Provider Business Mailing Address
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Address Line | 41620 W MARICOPA CASA GRANDE HWY STE 110
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City | MARICOPA
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State | AZ
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Zip | 85138-3217
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Country | US
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Telephone | 520-568-2800
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Fax | 520-568-3087
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. PAUL GEBHART
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Credential | DDS
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Telephone | 520-568-2800
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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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