Provider Demographics
NPI:1023598752
Name:GREAT BIG SMILES PLLC
Entity type:Organization
Organization Name:GREAT BIG SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, DHSC
Authorized Official - Phone:480-948-4200
Mailing Address - Street 1:7032 E COCHISE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-4565
Mailing Address - Country:US
Mailing Address - Phone:480-948-4200
Mailing Address - Fax:
Practice Address - Street 1:7032 E COCHISE RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4565
Practice Address - Country:US
Practice Address - Phone:480-948-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD07641261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental