CUSTOM SMILE LLC (NPI# 1710148663) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710148663 |
| Entity Type | Organization |
| Organization Name | CUSTOM SMILE LLC |
| Practice Address |
2919 S Ellsworth Rd Suite 141 Mesa AZ 85212-2164 |
| Practice Telephone | 4803078430 |
| Practice Fax Number | 4803078431 |
| Mailing Telephone | 4803078430 |
| Mailing Fax Number | 4803078431 |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2008-07-08 |
| Authorized Official Name | DR. STAN L COVINGTON (DENTIST) |
| Authorized Official Telephone | 4803078430 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 4675 | AZ | Dental Providers |
| Street Address |
2919 S ELLSWORTH RD SUITE 141 |
| City | MESA |
| State | AZ |
| Zip Code | 85212-2164 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972502862 | Gabriel U. Ogbonnaya | Internal Medicine | 2919 S Ellsworth Rd, Suite # 124, Mesa, AZ 85212-2164 | 2005-07-21 |
| 1154774305 | Mesa Physical Medicine Pllc | Nurse Practitioner | 2919 S Ellsworth Rd, Suite 102, Mesa, AZ 85212-2164 | 2016-07-22 |
| 1912331158 | Southwest Spine & Rehab Pllc | Chiropractor | 2919 S Ellsworth Rd, Suite 102, Mesa, AZ 85212-2164 | 2013-08-23 |
| 1225381999 | Amy Lynn Wagner | Naturopath | 2919 S Ellsworth Rd, Suite 109, Mesa, AZ 85212-2164 | 2012-10-18 |
| 1023381340 | Scott Alexander Taylor | Chiropractor | 2919 S Ellsworth Rd, 102, Mesa, AZ 85212-2164 | 2012-02-16 |
| 1326344375 | Choice Medical Imaging of Arizona, LLC | Clinic/Center | 2919 S Ellsworth Rd, Suite 101, Mesa, AZ 85212-2164 | 2011-02-08 |
| 1881928273 | Kate Ashley Maine | Physician Assistant | 2919 S Ellsworth Rd, Mesa, AZ 85212-2164 | 2009-10-01 |
| 1508024175 | Aimee Lynn Hada | Physician Assistant | 2919 S Ellsworth Rd, Ste. 124, Mesa, AZ 85212-2164 | 2008-05-29 |
| 1003089301 | Kristy K Brown | Speech-Language Pathologist | 2919 S Ellsworth Rd, Suite 111, Mesa, AZ 85212-2164 | 2008-04-08 |
| 1003089384 | Deborah A Mordhorst | Physical Therapist | 2919 S Ellsworth Rd, Suite 111, Mesa, AZ 85212-2164 | 2008-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922610302 | West Point Optical Group | Optometrist | 10706 E Point Twenty-two Blvd, #107, Mesa, AZ 85212 | 2020-08-18 |
| 1215553565 | Andrew Eugene Pak | Dentist | 10664 East Point Twenty-two Blvd, Mesa, AZ 85212 | 2020-06-23 |
| 1588200265 | Signal Butte Kids Dentistry and Orthodontics, LLP | Dentist | 10664 E. Point Twenty Two Blvd, Mesa, AZ 85212 | 2019-11-18 |
| 1194371526 | Safeway Inc | Durable Medical Equipment & Medical Supplies | 4316 S Signal Butte Rd, Mesa, AZ 85212 | 2019-08-12 |
| 1194200980 | Highbury Dental Management, LLC | Dentist | 4425 S Mountain Rd, Suite 109, Mesa, AZ 85212 | 2018-09-27 |
| 1033623541 | Latanya Olivia Edenburgs | Case Manager/Care Coordinator | 10436 E Radiant Ave., Mesa, AZ 85212 | 2017-11-20 |
| 1205355880 | Linda Okafor | Nurse Practitioner | 4719 S Calderon Circle, Mesa, AZ 85212 | 2017-09-14 |
| 1689121188 | Agh Mesa LLC | General Acute Care Hospital | 9130 East Elliot Road, Mesa, AZ 85212 | 2016-09-01 |
| 1861841918 | Ryan Blake | Dentist | 4425 S. Mountain Road, Ste 109, Mesa, AZ 85212 | 2016-06-09 |
| 1083089460 | White Glove Health | Nurse Practitioner | 2906 S Lynch Cr, Mesa, AZ 85212 | 2015-12-10 |
| Find all providers in zip 85212 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174149157 | Jordan Sunderhaus | Dentist | 1244 N Greenfield Rd Ste 103, Mesa, AZ 85205-4078 | 2020-06-25 |
| 1821613134 | Russell D York | Dentist | 1928 E Main St, Mesa, AZ 85203-9024 | 2020-06-11 |
| 1588200265 | Signal Butte Kids Dentistry and Orthodontics, LLP | Dentist | 10664 E. Point Twenty Two Blvd, Mesa, AZ 85212 | 2019-11-18 |
| 1184268310 | Ocotillo Sleep Solutions LLC | Dentist | 2150 S Dobson Rd Ste 3, Mesa, AZ 85202-6487 | 2019-10-31 |
| 1457906919 | Yana V Gerhardt | Dentist | 1822 S 39th St Unit 35, Mesa, AZ 85206-3828 | 2019-08-01 |
| 1538725387 | Dentists of Mesa, LLP | Dentist | 4401 E Mckellips Rd Ste 102, Mesa, AZ 85215-2558 | 2019-05-17 |
| 1417413063 | Peter Vu | Dentist | 5350 E Hilton Ave, Mesa, AZ 85206-5514 | 2019-02-19 |
| 1235604166 | Implant & Reconstructive Dentistry Pllc | Dentist | 1423 S Higley Rd Ste 117, Mesa, AZ 85206-3450 | 2018-10-07 |
| 1316423353 | Amberwood Dental Partners | Dentist | 840 E Mckellips Rd Ste 101, Mesa, AZ 85203-9654 | 2018-07-12 |
| 1386153823 | Angela S Wilson | Dentist | 1245 E Southern Ave Ste 12, Mesa, AZ 85204-5138 | 2017-09-27 |
| Find all providers in MESA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.