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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
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry

Other

Enumeration date
06/09/2010
Last updated
06/09/2010
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