NPIMap

Organization Active NPI

Super Smiles Maricopa PLLC

  • Pediatric Dentistry
  • Maricopa, AZ
National Provider Identifier
1891556502
Registry record updated Jan 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SUPER SMILES MARICOPA PLLC
Practice address
21116 N John Wayne Pkwy Ste B7
Maricopa, AZ 85139-2932
Phone
(520) 568-3828
Fax
(520) 568-0443
NPI assigned
Jan 19, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2024

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

Authorized official

Name
Nikita Kuppanda, DDSNPI 1649648668
Title
DDS/ Owner
Phone
(520) 568-3828

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 1

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

Addresses

Primary practice location

21116 N John Wayne Pkwy Ste B7
Maricopa, AZ 85139-2932

Mailing address

21116 N John Wayne Pkwy Ste B7
Maricopa, AZ 85139-2932
Phone (520) 568-3828

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1705622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1891556502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21116 N JOHN WAYNE PKWY STE B7",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851392932",
            "telephone_number": "520-568-3828",
            "fax_number": "520-568-0443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21116 N JOHN WAYNE PKWY STE B7",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851392932",
            "telephone_number": "520-568-3828",
            "fax_number": "520-568-0443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER SMILES MARICOPA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-19",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A",
        "authorized_official_last_name": "KUPPANDA",
        "authorized_official_first_name": "NIKITA",
        "authorized_official_title_or_position": "DDS/ OWNER",
        "authorized_official_telephone_number": "520-568-3828",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maricopa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; 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.