NPIMap

Organization Active NPI

Great Grins Children'S Dentistry, P.L.L.C.

  • Pediatric Dentistry
  • Tucson, AZ
National Provider Identifier
1134499007
Registry record updated May 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
6632 Issued in AZ
Legal business name
GREAT GRINS CHILDREN'S DENTISTRY, P.L.L.C.
Practice address
3953 E Paradise Falls Dr
Suite 110
Tucson, AZ 85712-6688
Phone
(520) 325-4746
Fax
(520) 319-1031
NPI assigned
Jan 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Angela Michele Wolfman, DDSNPI 1568531002
Title
Doctor/Owner
Phone
(520) 325-4746

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 6632 AZ Primary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 6742 AZ

Addresses

Primary practice location

3953 E Paradise Falls Dr
Suite 110
Tucson, AZ 85712-6688

Mailing address

3953 E Paradise Falls Dr
Suite 110
Tucson, AZ 85712-6688
Phone (520) 325-4746

Other identifiers 2

IdentifierTypeStateIssuer
977473MedicaidAZ
967177MedicaidAZ

National Provider Directory

National Provider Directory

Locations

3953 E Paradise Falls Dr
Ste 110
Tucson, AZ 85712
Phone (520) 323-0401

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368489600000",
    "number": "1134499007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3953 E PARADISE FALLS DR",
            "address_2": "SUITE 110",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857126688",
            "telephone_number": "520-325-4746",
            "fax_number": "520-319-1031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3953 E PARADISE FALLS DR",
            "address_2": "SUITE 110",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857126688",
            "telephone_number": "520-325-4746",
            "fax_number": "520-319-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT GRINS CHILDREN'S DENTISTRY, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-09",
        "last_updated": "2013-05-14",
        "status": "A",
        "authorized_official_last_name": "WOLFMAN",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "MICHELE",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "520-325-4746",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "6632",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "6742",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "977473",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "967177",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.