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Organization
SMILES DIVINE DENTAL TMD CRANIOFACIAL PAIN CENTER
Active
Organization
SMILES DIVINE DENTAL TMD CRANIOFACIAL PAIN CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NEIL DEPANTE TOBIAS (SOLE MEMBER)
(602) 283-3545
Entity
Organization
Contact information
Practice address
6003 W THUNDERBIRD RD STE 2, GLENDALE, AZ 85306-4004
(602) 283-3545
(602) 283-3545
Mailing address
6003 W THUNDERBIRD RD STE 2, GLENDALE, AZ 85306-4004
(602) 283-3545
(602) 283-3545
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5366
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
559809
—
AZ
Enumeration date
11/03/2014
Last updated
03/30/2016
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