Provider Demographics
NPI:1295083202
Name:SMILES BY DELIVERY, PLLC
Entity type:Organization
Organization Name:SMILES BY DELIVERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:CARMELLA
Authorized Official - Last Name:MAMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:602-717-7757
Mailing Address - Street 1:15508 W BELL RD
Mailing Address - Street 2:101-525
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2432
Mailing Address - Country:US
Mailing Address - Phone:623-584-4746
Mailing Address - Fax:623-584-4750
Practice Address - Street 1:15508 W BELL RD
Practice Address - Street 2:101-525
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2432
Practice Address - Country:US
Practice Address - Phone:623-584-4746
Practice Address - Fax:623-584-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-22
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH04804124Q00000X
AZH05302124Q00000X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty