Provider Demographics
NPI:1326128356
Name:GROWING GRINS PLLC
Entity Type:Organization
Organization Name:GROWING GRINS PLLC
Other - Org Name:GROWING GRINS PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-813-3636
Mailing Address - Street 1:413 E VAUGHN AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-6451
Mailing Address - Country:US
Mailing Address - Phone:480-205-0222
Mailing Address - Fax:
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD
Practice Address - Street 2:SUITE 130
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-4259
Practice Address - Country:US
Practice Address - Phone:480-813-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ57561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115115OtherAHCCCS