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Organization
AN ELEGANT SMILE P.C.
Active
Organization
AN ELEGANT SMILE P.C.
Active
Other names
An Elegant Smile Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA VITELA (CREDENTIALING COORDINATOR)
(602) 482-7000
Entity
Organization
Contact information
Practice address
1425 S GREENFIELD RD, BLDG 2 STE 110, MESA, AZ 85206-5529
(480) 854-3434
(480) 854-2640
Mailing address
1425 S GREENFIELD RD, BLDG 2 STE 110, MESA, AZ 85206-5529
(480) 854-3434
(480) 854-2640
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
NULL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
06/09/2010
Last updated
06/09/2010
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