MEDICARE: LITTLE SMILES OF SURPRISE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D5287	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000870541001	OTHER		UNITED CONCORDIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134181332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE SMILES OF SURPRISE

Provider Business Mailing Address
First Line	:	13915 N DYSART RD
Second Line	:	STE A1
City	:	EL MIRAGE
State	:	AZ
Zip	:	85335
Country	:	US
Telephone Number	:	623-444-6340
Fax Number	:	623-444-6350

Provider Business Practice Location Address
First Line	:	13915 N DYSART RD
Second Line	:	STE A1
City	:	EL MIRAGE
State	:	AZ
Zip	:	85335
Country	:	US
Telephone Number	:	623-444-6340
Fax Number	:	623-444-6350

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. LAURET SCHREIER
Credential	:	DDS
Telephone Number	:	623-444-6340

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	08/22/2020

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Directions to “LITTLE SMILES OF SURPRISE ” Practice Location

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