Kids Smiles Dental, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN13285 Issued in FL

Legal business name

KIDS SMILES DENTAL, PLLC

Practice address

1773 W Fletcher Ave
Tampa, FL 33612

Phone

(813) 968-2483

NPI assigned

Oct 27, 2016

Last updated

Jul 23, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

KIDS SMILES PARTNERS, PLLCAs reported in NPPES

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

Authorized official

Name

Mrs. Neely Jordan

Title

Director of Operations

Phone

(813) 968-2483

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532304000000",
    "number": "1033661848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1773 W FLETCHER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336121820",
            "telephone_number": "813-968-2483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1773 W FLETCHER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33612",
            "telephone_number": "813-968-2483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS SMILES DENTAL, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIDS SMILES PARTNERS, PLLC",
        "enumeration_date": "2016-10-27",
        "last_updated": "2018-07-23",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "NEELY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "813-968-2483",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN13285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "075109000",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017306300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kiddo-Land Therapy, Inc
• Kiddotherapy LLC
• Kidney Doctor, Corp.
• Kidneyspa Tampa Bay Home LLC
• Kids Home Care, Inc.
• Kids Smiles Pedo, PLLC
• Kelly Marie Kidwell, DMD
• Kristina Nikole Kidwell
• Taylor Kidwell, PT, DPT
• Valerie Kiefer, APRN

• Pediatric Dentistry in Tampa, FL
• Providers in Tampa, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2018; 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.