Healthcare Provider Details

I. General information

NPI: 1134181332
Provider Name (Legal Business Name): LITTLE SMILES OF SURPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13915 N DYSART RD STE A1
EL MIRAGE AZ
85335
US

IV. Provider business mailing address

13915 N DYSART RD STE A1
EL MIRAGE AZ
85335
US

V. Phone/Fax

Practice location:
  • Phone: 623-444-6340
  • Fax: 623-444-6350
Mailing address:
  • Phone: 623-444-6340
  • Fax: 623-444-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD5287
License Number StateAZ

VIII. Authorized Official

Name: DR. LAURET SCHREIER
Title or Position: DENTIST
Credential: DDS
Phone: 623-444-6340