Organization
AN ELEGANT SMILE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM FOREMAN (OWNER)
(480) 323-8537
Entity
Organization
Contact information
Practice address
14155 N 83RD AVE STE 113, PEORIA, AZ 85381-5655
(623) 486-5222
Mailing address
14155 N 83RD AVE STE 113, PEORIA, AZ 85381-5655
(623) 486-5222
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D009056
AZ
Other
Enumeration date
08/07/2014
Last updated
08/07/2014
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