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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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