Provider Demographics
NPI:1629554167
Name:GREAT SMILES DENTAL CARE
Entity Type:Organization
Organization Name:GREAT SMILES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WENDELSCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-606-2630
Mailing Address - Street 1:14800 W. MOUNTAIN VIEW BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85574
Mailing Address - Country:US
Mailing Address - Phone:623-933-5749
Mailing Address - Fax:623-815-1220
Practice Address - Street 1:14800 W. MOUNTAIN VIEW BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85574
Practice Address - Country:US
Practice Address - Phone:623-933-5749
Practice Address - Fax:623-815-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZB13724222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty