1285873125 NPI number — AN ELEGANT SMILE P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285873125 NPI number — AN ELEGANT SMILE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AN ELEGANT SMILE P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AN ELEGANT SMILE DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285873125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4550 E BELL RD STE 8-178
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-494-3000
Provider Business Mailing Address Fax Number:
602-494-3005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4550 E BELL RD STE 8-178
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85032-9306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-494-3000
Provider Business Practice Location Address Fax Number:
602-494-3005
Provider Enumeration Date:
02/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VITELA
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIAL COORDINATOR
Authorized Official Telephone Number:
602-482-7000

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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