Provider Demographics
NPI:1124494745
Name:LANDMARK SMILES OF SCOTTSDALE, INC.
Entity type:Organization
Organization Name:LANDMARK SMILES OF SCOTTSDALE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILDUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-234-9099
Mailing Address - Street 1:6920 E SHEA BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6180
Mailing Address - Country:US
Mailing Address - Phone:480-991-3244
Mailing Address - Fax:480-922-9253
Practice Address - Street 1:6920 E SHEA BLVD
Practice Address - Street 2:STE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6180
Practice Address - Country:US
Practice Address - Phone:480-991-3244
Practice Address - Fax:480-922-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0092441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty