Organization
AN ELEGANT SMILE P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA VITELA (CREDENTIALING COORDINATOR)
(602) 482-7000
Entity
Organization
Contact information
Practice address
980 WILLOW CREEK RD STE 103, PRESCOTT, AZ 86301-1619
(928) 445-1682
(928) 445-2963
Mailing address
980 WILLOW CREEK RD STE 103, PRESCOTT, AZ 86301-1619
(928) 445-1682
(928) 445-2963
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5979
AZ
Other
Enumeration date
09/02/2009
Last updated
09/02/2009
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