# GREAT GRINS DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144839390
- **Authorized official:** BRENT EUGENE FOSSUM DDS (DENTIST)
- **Authorized official phone:** (713) 972-2044

## Contact information

- **Practice address:** 5114 BALCONES WOODS DR STE 308, AUSTIN, TX 78759-5212
- **Practice address phone:** (512) 346-1900
- **Mailing address:** 5672 RAIN CREEK PKWY, AUSTIN, TX 78759-6201
- **Mailing address phone:** (713) 972-2044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/23/2020
- **Last updated:** 07/23/2020