NPIMap

Organization Active NPI

Smile Phoenix PLLC

  • General Practice Dentistry
  • Phoenix, AZ
National Provider Identifier
1093024341
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2191 Issued in AZ
Legal business name
SMILE PHOENIX PLLC
Practice address
2330 N 75TH Ave Ste 112
Phoenix, AZ 85035-1200
Phone
(623) 849-0477
Fax
(623) 849-6111
NPI assigned
Oct 5, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Douglas Gordon, D.D.S
Title
President
Phone
(623) 362-8200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2191 AZ Primary

Addresses

Primary practice location

2330 N 75TH Ave Ste 112
Phoenix, AZ 85035-1200

Mailing address

2330 N 75TH Ave Ste 112
Phoenix, AZ 85035-1200
Phone (623) 849-0477

Other names 1

  • Smile Fitness Dental Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1093024341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 N 75TH AVE STE 112",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850351200",
            "telephone_number": "623-849-0477",
            "fax_number": "623-849-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 N 75TH AVE STE 112",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850351200",
            "telephone_number": "623-849-0477",
            "fax_number": "623-849-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE PHOENIX PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-05",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "623-362-8200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "2191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Fitness Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.