# AN ELEGANT SMILE P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** An Elegant Smile Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053631309
- **Authorized official:** MONICA VITELA (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (602) 482-7000

## Contact information

- **Practice address:** 1425 S GREENFIELD RD, BLDG 2 STE 110, MESA, AZ 85206-5529
- **Practice address phone:** (480) 854-3434
- **Practice address fax:** (480) 854-2640
- **Mailing address:** 1425 S GREENFIELD RD, BLDG 2 STE 110, MESA, AZ 85206-5529
- **Mailing address phone:** (480) 854-3434
- **Mailing address fax:** (480) 854-2640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 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