Healthcare Provider Details

I. General information

NPI: 1326128356
Provider Name (Legal Business Name): GROWING GRINS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 E CHANDLER HEIGHTS RD SUITE 130
GILBERT AZ
85297-4259
US

IV. Provider business mailing address

413 E VAUGHN AVE
GILBERT AZ
85234-6451
US

V. Phone/Fax

Practice location:
  • Phone: 480-813-3636
  • Fax:
Mailing address:
  • Phone: 480-205-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberAZ5756
License Number StateAZ

VIII. Authorized Official

Name: DR. LIOR BERGER
Title or Position: OWNER
Credential: DMD
Phone: 480-813-3636