Provider Demographics
NPI:1053022129
Name:MESA SMILES DENTISTRY
Entity type:Organization
Organization Name:MESA SMILES DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALHARETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:716-430-5757
Mailing Address - Street 1:6035 N 83RD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5841
Mailing Address - Country:US
Mailing Address - Phone:716-430-5757
Mailing Address - Fax:
Practice Address - Street 1:849 N DOBSON RD STE 108
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7596
Practice Address - Country:US
Practice Address - Phone:480-834-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty