Organization
MODERN SMILES PLLC
Active
Other names
Modern Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
2933 W CACTUS RD, PHOENIX, AZ 85029-2346
(602) 863-9079
Mailing address
2933 W CACTUS RD, PHOENIX, AZ 85029-2346
(602) 863-9079
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/08/2024
Last updated
01/08/2024
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