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General NPI Number Information
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NPI Number | 1629554167
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Entity Type | Organization
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Legal Business Name | GREAT SMILES DENTAL CARE
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 14800 W. MOUNTAIN VIEW BLVD SUITE 200
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City | SURPRISE
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State | AZ
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Zip | 85574
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Country | US
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Telephone | 623-933-5749
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Fax | 623-815-1220
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Provider Business Mailing Address
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Address Line | 14800 W. MOUNTAIN VIEW BLVD SUITE 200
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City | SURPRISE
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State | AZ
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Zip | 85574
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Country | US
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Telephone | 623-933-5749
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Fax | 623-815-1220
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ERIC PAUL WENDELSCHAFER
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Credential | DMD
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Telephone | 480-606-2630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | B13724222
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License Number State | AZ
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