# GREAT SMILE DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Great Smile Dental Las Vegas, Great Smile Dental PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568071827
- **Authorized official:** JACQUELINE MORALES (DISTRICT MANAGER)
- **Authorized official phone:** (847) 945-1050

## Contact information

- **Practice address:** 8445 W FLAMINGO RD, LAS VEGAS, NV 89147-4166
- **Practice address phone:** (702) 309-0909
- **Practice address fax:** (725) 228-7025
- **Mailing address:** 720 OSTERMAN AVE STE 304, DEERFIELD, IL 60015-4339
- **Mailing address phone:** (847) 945-1050
- **Mailing address fax:** (847) 940-0433

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223D0001X | Public Health Dentistry | — | NULL | Yes |
| 1223D0001X | Public Health Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/23/2020
- **Last updated:** 09/16/2020