Henderson Pediatric Dentistry Hon DMD PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

HENDERSON PEDIATRIC DENTISTRY HON DMD PC

Doing business as

Cosmic Kids Dental

Practice address

390 N Stephanie St Ste 104
Henderson, NV 89014-8029

Phone

(702) 947-7700

NPI assigned

Jun 11, 2019

Organization subpart

No

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

Authorized official

Name

Magdalena Evans

Title

Credentialing Specialist

Phone

(720) 603-4788

Specialties & licenses 1

Addresses

Other names 1

• Cosmic Kids Dental Doing business as

Locations

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728864000000",
    "number": "1033778220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 N STEPHANIE ST STE 104",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890148029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 N STEPHANIE ST STE 104",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890148029",
            "telephone_number": "702-947-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON PEDIATRIC DENTISTRY HON DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-11",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "MAGDALENA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "720-603-4788"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cosmic Kids Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cosmic Kids Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Henderson Knee and Joint Clinic LLC
• Henderson Long Term Care LLC (Green Valley Health and Wellness Suites)
• Henderson Modern Dentistry
• Henderson OB/GYN LLC
• Henderson Operating Company LLC (Lake Mead Health & Rehabilitation Center)
• Henderson Pediatric Dentistry PC
• Henderson Pediatrics PLLC
• Henderson Pediatrics, LLP
• Henderson Pharmacy LLC (Henderson Pharmacy)
• Henderson Primary, Professional LLC

• Dentist in Henderson, NV
• Providers in Henderson, NV by specialty
• Dentist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; 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.