Provider Demographics
NPI:1528440401
Name:SMILE CLINIQUE GILBERT
Entity type:Organization
Organization Name:SMILE CLINIQUE GILBERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:408-234-5099
Mailing Address - Street 1:110 S VAL VISTA DR STE B7
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1373
Mailing Address - Country:US
Mailing Address - Phone:480-545-3440
Mailing Address - Fax:
Practice Address - Street 1:110 S VAL VISTA DR STE B7
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1373
Practice Address - Country:US
Practice Address - Phone:480-545-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental