Provider Demographics
NPI:1699324244
Name:SMILE DENTAL LLC
Entity type:Organization
Organization Name:SMILE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ASEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-855-6300
Mailing Address - Street 1:1960 W RAY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-9009
Mailing Address - Country:US
Mailing Address - Phone:480-855-6300
Mailing Address - Fax:480-855-6301
Practice Address - Street 1:1960 W RAY RD STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-9009
Practice Address - Country:US
Practice Address - Phone:480-855-6300
Practice Address - Fax:480-855-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center