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General NPI Number Information
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NPI Number | 1962929851
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Entity Type | Organization
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Legal Business Name | SOLRAC SMILES LLC
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 09/12/2017
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Provider Practice Location Address
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Address Line | 3014 N HAYDEN RD STE 104
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6531
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Country | US
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Telephone | 480-747-1352
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Fax |
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Provider Business Mailing Address
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Address Line | 1902 W CORTEZ CIR
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City | CHANDLER
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State | AZ
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Zip | 85224-1294
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Country | US
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Telephone | 480-330-0714
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROGEL CARLOS
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Credential |
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Telephone | 480-330-0714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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