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General NPI Number Information
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NPI Number | 1023598752
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Entity Type | Organization
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Legal Business Name | GREAT BIG SMILES PLLC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 7032 E COCHISE RD STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85253-4565
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Country | US
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Telephone | 480-948-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 7032 E COCHISE RD STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85253-4565
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Country | US
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Telephone | 480-948-4200
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MICHAEL BOWEN
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Credential | DMD, DHSC
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Telephone | 480-948-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D07641
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License Number State | AZ
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