Provider Demographics
NPI:1184347833
Name:KIDS GRINS-QUEEN CREEK
Entity type:Organization
Organization Name:KIDS GRINS-QUEEN CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-284-6630
Mailing Address - Street 1:20261 E OCOTILLO RD STE 130
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:480-590-4436
Practice Address - Street 1:20261 E OCOTILLO RD STE 130
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-8806
Practice Address - Country:US
Practice Address - Phone:480-284-6630
Practice Address - Fax:480-590-4436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN W. TAYLOR, DDS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-19
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty