Provider Demographics
NPI:1902250368
Name:ARIZONA SMILES, P.C.
Entity Type:Organization
Organization Name:ARIZONA SMILES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:BOLLWINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-892-5089
Mailing Address - Street 1:1400 N GILBERT ROAD
Mailing Address - Street 2:SUITE Z
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-892-5089
Mailing Address - Fax:480-892-4236
Practice Address - Street 1:1400 N GILBERT RD
Practice Address - Street 2:SUITE Z
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2328
Practice Address - Country:US
Practice Address - Phone:480-892-5089
Practice Address - Fax:480-892-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty