Organization
PEORIA DENTAL SMILES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERA NIEDENS (ACCOUNTANT)
(623) 289-2616
Entity
Organization
Contact information
Practice address
9059 W LAKE PLEASANT PKWY STE A100, PEORIA, AZ 85382-8393
(623) 572-0102
Mailing address
34225 N 27TH DR STE 241, PHOENIX, AZ 85085-6091
(623) 289-2616
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/28/2022
Last updated
11/28/2022
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