Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Custom Smile LLC

Organization Dentist · NPI 1710148663

Custom Smile LLC provides Dentist services 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 Not confirmed with CMS for 18 years — call before visiting
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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