Organization
SUPER SMILES FOR KIDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORA PESQUEDA (DIRECTOR/ MEMBER)
(520) 442-0332
Entity
Organization
Contact information
Practice address
1285 E SUNSET DR, CASA GRANDE, AZ 85122-2942
(520) 442-0332
Mailing address
1285 E SUNSET DR, CASA GRANDE, AZ 85122-2942
(520) 442-0332
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
07288
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070408
—
AZ
05
—
098601
—
AZ
Enumeration date
01/14/2016
Last updated
04/03/2026
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