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General NPI Number Information
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NPI Number | 1184347833
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Entity Type | Organization
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Legal Business Name | KIDS GRINS-QUEEN CREEK
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 20261 E OCOTILLO RD STE 130
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-8806
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Country | US
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Telephone | 480-284-6630
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Fax | 480-590-4436
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Provider Business Mailing Address
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Address Line | 20261 E OCOTILLO RD STE 130
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-8806
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Country | US
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Telephone |
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Fax | 480-590-4436
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TESSA BAUGHN
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Credential |
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Telephone | 480-284-6630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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