| Magic Smiles Dental Care | |
|
1701 E Thomas Rd #204 Phoenix AZ 85016 | |
| (602) 253-6600 | |
| (602) 279-0821 |
| Full Name | Magic Smiles Dental Care |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1701 E Thomas Rd #204, Phoenix, Arizona |
| Authorized Official Name and Position | Amanda J Trujillo (CREDENTIALING MANAGER) |
| Authorized Official Contact | 6022536600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Magic Smiles Dental Care 1701 E Thomas Rd Ste 204 Phoenix AZ 85016-7675 Ph: (602) 253-6600 | Magic Smiles Dental Care 1701 E Thomas Rd #204 Phoenix AZ 85016 Ph: (602) 253-6600 |
| NPI Number | 1134345937 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 02/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134345937 | NPI | - | NPPES |
| 232643 | Other | AZ | AHCCCS PROVIDER ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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