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NPI Code Detail

MEDICARE: AN ELEGANT SMILE P.C.

MEDICARE: AN ELEGANT SMILE P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)
21223X0400XOrthodontics and Dentofacial Orthopedics Dentistry
31223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1053631309
Entity Type Code : Organization
Provider Name (Legal Business Name) : AN ELEGANT SMILE P.C.
Provider Business Mailing Address
First Line : 1425 S GREENFIELD RD
Second Line : BLDG 2 STE 110
City : MESA
State : AZ
Zip : 85206-5529
Country : US
Telephone Number : 480-854-3434
Fax Number : 480-854-2640
Provider Business Practice Location Address
First Line : 1425 S GREENFIELD RD
Second Line : BLDG 2 STE 110
City : MESA
State : AZ
Zip : 85206-5529
Country : US
Telephone Number : 480-854-3434
Fax Number : 480-854-2640
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : MONICA VITELA
Credential :
Telephone Number : 602-482-7000
Provider Enumeration Date : 06/09/2010
Last Update Date : 06/09/2010

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Directions to “AN ELEGANT SMILE P.C. ” Practice Location

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