NPIMap

Organization Active NPI

Northern Nevada Dental Specialties Group, LLC

Doing business as My Kids Smile

  • Pediatric Dentistry
  • Reno, NV
National Provider Identifier
1043725039
Registry record updated Dec 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
NORTHERN NEVADA DENTAL SPECIALTIES GROUP, LLC
Doing business as
My Kids Smile
Practice address
5030 Las Brisas Blvd Ste B-3
Reno, NV 89523-6239
Phone
(775) 852-6164
Fax
(775) 284-7352
NPI assigned
Dec 12, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2017

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

Authorized official

Name
Aleta Valerie Beuter
Title
Credentialing Specialist
Phone
(775) 409-4614

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

5030 Las Brisas Blvd Ste B-3
Reno, NV 89523-6239

Mailing address

3605 Grant Dr
Reno, NV 89509-5301
Phone (775) 409-4614

Other identifiers 1

IdentifierTypeStateIssuer
1223P0221XOtherPEDIATRIC DENTISTRY

Other names 1

  • My Kids Smile Doing business as

National Provider Directory

National Provider Directory
Tax ID family
My Kid's Smile4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5030 Las Brisas Blvd
Ste B3
Reno, NV 89523
Phone (775) 852-6164

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1513036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513036800000",
    "number": "1043725039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 GRANT DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895095301",
            "telephone_number": "775-409-4614",
            "fax_number": "775-376-9075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5030 LAS BRISAS BLVD STE B-3",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895236239",
            "telephone_number": "775-852-6164",
            "fax_number": "775-284-7352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN NEVADA DENTAL SPECIALTIES GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-12",
        "last_updated": "2017-12-12",
        "status": "A",
        "authorized_official_last_name": "BEUTER",
        "authorized_official_first_name": "ALETA",
        "authorized_official_middle_name": "VALERIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "775-409-4614"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEDIATRIC DENTISTRY",
            "identifier": "1223P0221X",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Kids Smile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2017; 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.