NPIMap

Organization Active NPI

RJ Smiles, LLC

  • Dentist
  • Jackson, WY
National Provider Identifier
1063539963
Registry record updated Oct 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
RJ SMILES, LLC
Practice address
610 West Broadway Ave
Suite 106
Jackson, WY 83001
Phone
(307) 732-2273
Fax
(307) 732-1660
NPI assigned
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2025

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

Authorized official

Name
Paula J Ridgeway, DDS
Title
Managing Partner
Phone
(307) 732-2273

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X

Addresses

Primary practice location

610 West Broadway Ave
Suite 106
Jackson, WY 83001

Mailing address

P.O. Box 9340
Jackson, WY 83002-9340
Phone (307) 732-2273

Other identifiers 1

IdentifierTypeStateIssuer
119801700MedicaidWY

Other names 2

  • DENTAL CARE OF JACKSON HOLE Doing business as
  • Joshua G. Wagner DDS PC Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761177600000",
    "number": "1063539963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 9340",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830029340",
            "telephone_number": "307-732-2273",
            "fax_number": "307-732-1660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 WEST BROADWAY AVE",
            "address_2": "SUITE 106",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83001",
            "telephone_number": "307-732-2273",
            "fax_number": "307-732-1660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RJ SMILES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2025-10-23",
        "certification_date": "2025-10-23",
        "status": "A",
        "authorized_official_last_name": "RIDGEWAY",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "307-732-2273",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119801700",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DENTAL CARE OF JACKSON HOLE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Joshua G. Wagner DDS PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jackson, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2025; 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.