NPIMap

Organization Active NPI

Custom Smile LLC

  • Dentist
  • Mesa, AZ
National Provider Identifier
1710148663
Registry record updated Jul 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4675 Issued in AZ
Legal business name
CUSTOM SMILE LLC
Practice address
2919 S Ellsworth Rd
Suite 141
Mesa, AZ 85212-2164
Phone
(480) 307-8430
Fax
(480) 307-8431
NPI assigned
Jun 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2008

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

Authorized official

Name
Dr. Stan L Covington, DDSNPI 1154478808
Title
Dentist
Phone
(480) 307-8430

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 4675 AZ Primary

Addresses

Primary practice location

2919 S Ellsworth Rd
Suite 141
Mesa, AZ 85212-2164

Mailing address

2919 S Ellsworth Rd
Suite 141
Mesa, AZ 85212-2164
Phone (480) 307-8430

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215475200000",
    "number": "1710148663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2919 S ELLSWORTH RD",
            "address_2": "SUITE 141",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852122164",
            "telephone_number": "480-307-8430",
            "fax_number": "480-307-8431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2919 S ELLSWORTH RD",
            "address_2": "SUITE 141",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852122164",
            "telephone_number": "480-307-8430",
            "fax_number": "480-307-8431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM SMILE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-23",
        "last_updated": "2008-07-08",
        "status": "A",
        "authorized_official_last_name": "COVINGTON",
        "authorized_official_first_name": "STAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "480-307-8430",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "4675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; 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.