| Super Smiles For Kids, Llc | |
|
21116 N John Wayne Pkwy Ste B7 Maricopa AZ 85139-2932 | |
| (520) 568-1551 | |
| (520) 423-3912 |
| Full Name | Super Smiles For Kids, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 21116 N John Wayne Pkwy Ste B7, Maricopa, Arizona |
| Authorized Official Name and Position | Matthew Roper (OWNER/DENTIST) |
| Authorized Official Contact | 5205681551 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Super Smiles For Kids, Llc 21116 N John Wayne Pkwy Ste B7 Maricopa AZ 85139-2932 Ph: (520) 568-1551 | Super Smiles For Kids, Llc 21116 N John Wayne Pkwy Ste B7 Maricopa AZ 85139-2932 Ph: (520) 568-1551 |
| NPI Number | 1750747150 |
|---|---|
| Provider Enumeration Date | 01/14/2016 |
| Last Update Date | 01/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750747150 | NPI | - | NPPES |
| 070408 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 07288 (Arizona) | Primary |
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