| NPI | 1356622435 |
|---|---|
| Doing Business As | DBA SMILES ON BROADWAY |
| Entity Type | Organization |
| Authorized Contact | TAROLL A GRAZIANO Manager 623-556-7789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D7840) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D7840) |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2011-09-02 |