Organization
DRS OF SMILES PC
Active
Organization
DRS OF SMILES PC
Active
Other names
Scott Lesueur and Charles Dodaro DDS
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT TAYLOR LESUEUR DDS (PRESIDENT)
(480) 834-6991
Entity
Organization
Contact information
Practice address
1056 S VAL VISTA DR, STE 1, MESA, AZ 85204-5625
(480) 834-6991
(480) 654-8836
Mailing address
1056 S VAL VISTA DR, STE 1, MESA, AZ 85204-5625
(480) 834-6991
(480) 654-8836
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
2695
AZ
302F00000X
Exclusive Provider Organization
Primary
3434
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2695
ARIZONA MED LIC DENTAL
AZ
01
—
3434
ARIZONA MED LIC DENTAL
AZ
Enumeration date
11/01/2006
Last updated
02/15/2011
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