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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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