| Custom Smile Llc | |
|
2919 S Ellsworth Rd Suite 141 Mesa AZ 85212-2164 | |
| (480) 307-8430 | |
| (480) 307-8431 |
| Full Name | Custom Smile Llc |
|---|---|
| Speciality | Dentist |
| Location | 2919 S Ellsworth Rd, Mesa, Arizona |
| Authorized Official Name and Position | Stan L Covington (DENTIST) |
| Authorized Official Contact | 4803078430 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Custom Smile Llc 2919 S Ellsworth Rd Suite 141 Mesa AZ 85212-2164 Ph: (480) 307-8430 | Custom Smile Llc 2919 S Ellsworth Rd Suite 141 Mesa AZ 85212-2164 Ph: (480) 307-8430 |
| NPI Number | 1710148663 |
|---|---|
| Provider Enumeration Date | 06/23/2008 |
| Last Update Date | 07/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710148663 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 4675 (Arizona) | Primary |
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