Legendary Smiles, P.C.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

2238 Issued in ND

Legal business name

LEGENDARY SMILES, P.C.

Doing business as

Legendary Smiles

Practice address

109 5TH St SW
Watford City, ND 58854-7135

Phone

(701) 842-4474

Fax

(701) 842-4472

NPI assigned

Apr 25, 2016

Last updated

Apr 25, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Monty Stewart Bulzomi, D.D.S

Title

Owner/Dentist

Phone

(701) 842-4474

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Legendary Smiles Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461542400000",
    "number": "1023463320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 5TH ST SW",
            "address_2": "PO BOX 486",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588547135",
            "telephone_number": "701-842-4474",
            "fax_number": "701-842-4472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 5TH ST SW",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588547135",
            "telephone_number": "701-842-4474",
            "fax_number": "701-842-4472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGENDARY SMILES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-25",
        "last_updated": "2016-04-25",
        "status": "A",
        "authorized_official_last_name": "BULZOMI",
        "authorized_official_first_name": "MONTY",
        "authorized_official_middle_name": "STEWART",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "701-842-4474",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ND",
            "license": "2238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1464401",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legendary Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kara Lynn Marie Langowski
• Larsen Service Drug Inc
• Larry C. Larsen, R.PH.
• John Larson
• Legendary Smiles Dental Group (Legendary Smiles)
• Lev3L Performance Physical Therapy
• Kelsey Nicole Linseth, PHARM D
• Claudia H Low, APRN, ACNS-BC
• Maisey Dental
• Matthew L Maunu, MD

• Dental Clinic/Center in Watford City, ND
• Providers in Watford City, ND by specialty
• Dental Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.