Provider Demographics
NPI:1134181332
Name:LITTLE SMILES OF SURPRISE
Entity type:Organization
Organization Name:LITTLE SMILES OF SURPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURET
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-444-6340
Mailing Address - Street 1:13915 N DYSART RD
Mailing Address - Street 2:STE A1
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335
Mailing Address - Country:US
Mailing Address - Phone:623-444-6340
Mailing Address - Fax:623-444-6350
Practice Address - Street 1:13915 N DYSART RD
Practice Address - Street 2:STE A1
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335
Practice Address - Country:US
Practice Address - Phone:623-444-6340
Practice Address - Fax:623-444-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD52871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000870541001OtherUNITED CONCORDIA
AZ611922Medicaid