Organization · NPI-2

An Elegant Smile P.C.

Dentist, General Practice · Peoria, AZ

NPI number1760797146
StatusActive
Last updated in NPPESAug 10, 2010

Details

NPI
1760797146
Entity type
Organization (NPI-2)
Legal business name
An Elegant Smile P.C.
Organization subpart
No
Enumeration date
Aug 10, 2010
Last updated
Aug 10, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice3531AZYes

Other names

  • An Elegant Smile Denistry (Doing Business As)

Practice location

14155 N 83rd Ave Bldg 3
Peoria, AZ 85381-5639

Phone 623-486-5222 · Fax 623-486-5226

Mailing address

14155 N 83rd Ave Bldg 3
Peoria, AZ 85381-5639

Phone 623-486-5222 · Fax 623-486-5226

Authorized official

Monica Vitela
Credentialing Coordinator
6024827000

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