Provider Demographics
NPI:1194736843
Name:ARIZONA SMILE DESIGN
Entity type:Organization
Organization Name:ARIZONA SMILE DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-881-8875
Mailing Address - Street 1:13920 W. CAMINO DEL SOL
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-4639
Mailing Address - Country:US
Mailing Address - Phone:623-474-3343
Mailing Address - Fax:623-975-7063
Practice Address - Street 1:13830 W CAMINO DEL SOL
Practice Address - Street 2:SUITE 200
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4485
Practice Address - Country:US
Practice Address - Phone:623-474-3343
Practice Address - Fax:623-533-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty