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General NPI Number Information
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NPI Number | 1710741673
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Entity Type | Organization
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Legal Business Name | GROWING SMILES, LLC
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 11149 RESEARCH BLVD STE 270
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City | AUSTIN
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State | TX
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Zip | 78759-5227
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Country | US
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Telephone | 208-690-0367
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Fax |
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Provider Business Mailing Address
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Address Line | 10510 W PARMER LN STE 100
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City | AUSTIN
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State | TX
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Zip | 78717-4876
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Country | US
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Telephone | 512-265-5900
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Fax | 512-256-6950
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Authorized Official
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Title or Position | CEO
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Name | DR. JAMIE FAIRCHILD
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Credential | DMD
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Telephone | 208-690-0367
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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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