# MILL AVENUE FAMILY DENTISTRY PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tempe Smile Design
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245309640
- **Authorized official:** DR. STACY TRACY DDS (PRESIDENT CO-OWNER)
- **Authorized official phone:** (480) 829-8200

## Contact information

- **Practice address:** 1712 E GUADALUPE RD, SUITE 109, TEMPE, AZ 85283-3983
- **Practice address phone:** (480) 829-8200
- **Practice address fax:** (480) 967-5252
- **Mailing address:** 1712 E GUADALUPE RD, SUITE 109, TEMPE, AZ 85283-3983
- **Mailing address phone:** (480) 829-8200
- **Mailing address fax:** (480) 967-5252

## Taxonomy

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

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 04/26/2012