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General NPI Number Information
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NPI Number | 1851428254
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Entity Type | Organization
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Legal Business Name | SAN TAN SMILES FAMILY DENTISTRY
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1355 S HIGLEY RD SUITE 114
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City | HIGLEY
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State | AZ
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Zip | 85236-4705
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Country | US
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Telephone | 480-457-8818
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Fax | 480-457-8785
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Provider Business Mailing Address
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Address Line | 1355 S HIGLEY RD SUITE 114
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City | HIGLEY
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State | AZ
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Zip | 85236-4705
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Country | US
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Telephone | 480-457-8818
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Fax | 480-457-8785
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARY LOU JONES
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Credential |
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Telephone | 480-457-8818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2527
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License Number State | AZ
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