Organization
CUSTOM SMILE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STAN L COVINGTON DDS (DENTIST)
(480) 307-8430
Entity
Organization
Contact information
Practice address
2919 S ELLSWORTH RD, SUITE 141, MESA, AZ 85212-2164
(480) 307-8430
(480) 307-8431
Mailing address
2919 S ELLSWORTH RD, SUITE 141, MESA, AZ 85212-2164
(480) 307-8430
(480) 307-8431
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4675
AZ
Other
Enumeration date
06/23/2008
Last updated
07/08/2008
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