Provider Demographics
NPI:1497026728
Name:GIGGLES & GRINS PEDIATRIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:GIGGLES & GRINS PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-488-3533
Mailing Address - Street 1:2915 E SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6626
Mailing Address - Country:US
Mailing Address - Phone:817-488-3533
Mailing Address - Fax:817-421-9221
Practice Address - Street 1:2915 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6626
Practice Address - Country:US
Practice Address - Phone:817-488-3533
Practice Address - Fax:817-421-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty