Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Custom Smile LLC

Organization Dentist · NPI 1710148663

Custom Smile LLC is a Dentist in Mesa, Arizona. Licensed in Arizona. Registered with an NPI since 2008.

Licensed in
AZ
In the registry since
2008
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2919 S Ellsworth Rd Ste 141
Mesa, AZ 85212-2164
Phone: (480) 307-8430
Fax: (480) 307-8431
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 4675 (AZ)

Record details

NPI number1710148663
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Stan Covington — Dentist · (480) 307-8430
NPI enumeratedJune 23, 2008
Last updated in NPPESJuly 8, 2008
Mailing address2919 S Ellsworth Rd, Suite 141, Mesa, AZ 85212-2164

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