MEDICARE: GREAT SMILES DENTAL GROUP LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1881302586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT SMILES DENTAL GROUP LLC

Provider Business Mailing Address
First Line	:	34225 N 27TH DR STE 241
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-6091
Country	:	US
Telephone Number	:	623-289-2616
Fax Number	:

Provider Business Practice Location Address
First Line	:	14800 W MOUNTAIN VIEW BLVD STE 200
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-2703
Country	:	US
Telephone Number	:	623-933-5749
Fax Number	:

Authorized Official
Title or Position	:	ACCOUNTANT
Name	:	TERA NIEDENS
Credential	:
Telephone Number	:	623-289-2616

Provider Enumeration Date	:	11/10/2022
Last Update Date	:	11/10/2022

Similar Medicare Providers

1417560806 — RUSSELL PRAUSE MS, LPC-S
Practice Location Address:

14800 W MOUNTAIN VIEW BLVD STE 210
SURPRISE, AZ
85374-2703

Practice Phone: 623-888-4310
Practice Fax:

1922594522 — EBW DMD PLLC
Practice Location Address:

14800 W MOUNTAIN VIEW BLVD STE 200
SURPRISE, AZ
85374-2703

Practice Phone: 623-933-5749
Practice Fax:

1952904153 — MICHELLE F MULNIX
Practice Location Address:

14800 W MOUNTAIN VIEW BLVD STE 210
SURPRISE, AZ
85374-2703

Practice Phone: 623-202-2521
Practice Fax:

1750116620 — ANTHONY JAMES ERVIN
Practice Location Address:

14800 W MOUNTAIN VIEW BLVD STE 210
SURPRISE, AZ
85374-2703

Practice Phone: 623-202-2521
Practice Fax:

1083406722 — ALLIANCE WOUND CARE SERVICES PLLC
Practice Location Address:

17316 N KIMBERLY WAY
SURPRISE, AZ
85374-9686

Practice Phone: 575-491-5367
Practice Fax:

1376997130 — MS. BRENDA LEA BAKER NP-C
Practice Location Address:

17316 N KIMBERLY WAY
SURPRISE, AZ
85374-9686

Practice Phone: 575-491-5367
Practice Fax:

Directions to “GREAT SMILES DENTAL GROUP LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.