Provider Demographics
NPI:1033973524
Name:COMMUNITY OF SMILES OUTREACH
Entity type:Organization
Organization Name:COMMUNITY OF SMILES OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:RCM
Authorized Official - Phone:818-522-1259
Mailing Address - Street 1:2174 E WILLIAMS FIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0160
Mailing Address - Country:US
Mailing Address - Phone:480-476-8785
Mailing Address - Fax:
Practice Address - Street 1:2174 E WILLIAMS FIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0160
Practice Address - Country:US
Practice Address - Phone:480-476-8785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty