Great Smiles Dental Group LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

GREAT SMILES DENTAL GROUP LLC

Practice address

14800 W Mountain View Blvd Ste 200
Surprise, AZ 85374-2703

Phone

(623) 933-5749

NPI assigned

Nov 10, 2022

Organization subpart

No

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

Authorized official

Name

Tera Niedens

Title

Accountant

Phone

(623) 289-2616

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1668038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1881302586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34225 N 27TH DR STE 241",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850856091",
            "telephone_number": "623-289-2616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14800 W MOUNTAIN VIEW BLVD STE 200",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853742703",
            "telephone_number": "623-933-5749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT SMILES DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-10",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "NIEDENS",
        "authorized_official_first_name": "TERA",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "623-289-2616"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Surprise",
            "affiliation": "N",
            "address_1": "14800 W Mountain View Blvd Ste 200",
            "city": "Surprise",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "853742703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kyla Camille Gray, MSN, FNP-C, PMHNP-C
• Byron Kent Grayson, P.A
• Mary Ellen Grayson
• Brenda Graziano, LMSW
• Great Smiles Dental Care
• Adara Greathouse
• Donovan Greathouse
• Charise Green, RB
• Chelsea Green
• Lauryn Cate Green

• Dental Clinic/Center in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Dental Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; 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.