MEDICARE: GROWING GRINS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	AZ5756	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	115115	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1326128356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWING GRINS PLLC

Provider Business Mailing Address
First Line	:	413 E VAUGHN AVE
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-6451
Country	:	US
Telephone Number	:	480-205-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3336 E CHANDLER HEIGHTS RD
Second Line	:	SUITE 130
City	:	GILBERT
State	:	AZ
Zip	:	85297-4259
Country	:	US
Telephone Number	:	480-813-3636
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LIOR BERGER
Credential	:	DMD
Telephone Number	:	480-813-3636

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/22/2020

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Directions to “GROWING GRINS PLLC ” Practice Location

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