Healthcare Provider Details

I. General information

NPI: 1811820095
Provider Name (Legal Business Name): LITTLE AND BIG SMILES DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8419 E BASELINE RD STE 101
MESA AZ
85209-4380
US

IV. Provider business mailing address

2079 E SADDLEBROOK CT
GILBERT AZ
85298-7416
US

V. Phone/Fax

Practice location:
  • Phone: 703-819-7037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAZAN NOUR
Title or Position: MEMBER
Credential:
Phone: 916-904-6236