Provider Demographics
NPI:1801166491
Name:SMILES OF AMERICA-RANCHO SOLANO PLLC
Entity type:Organization
Organization Name:SMILES OF AMERICA-RANCHO SOLANO PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:602-864-1119
Mailing Address - Street 1:2401 W GLENDALE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7677
Mailing Address - Country:US
Mailing Address - Phone:602-864-1119
Mailing Address - Fax:
Practice Address - Street 1:2401 W GLENDALE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7677
Practice Address - Country:US
Practice Address - Phone:602-864-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF0003741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty