NPIMap

Organization Active NPI

Northern Nevada Dental Specialty Group

Doing business as My Kid's Smile

  • Dentist
  • Sparks, NV
National Provider Identifier
1073995213
Registry record updated Jun 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4489 Issued in NV
Legal business name
NORTHERN NEVADA DENTAL SPECIALTY GROUP
Doing business as
My Kid's Smile
Practice address
3150 Vista Blvd
Suite 110
Sparks, NV 89436-6712
Phone
(775) 852-6164
NPI assigned
Jun 24, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2015

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

Authorized official

Name
Mr. Nicholas Channing Christiansen
Title
Manager
Phone
(775) 848-3005

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 4489 NV Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 36-117 NV

Addresses

Primary practice location

3150 Vista Blvd
Suite 110
Sparks, NV 89436-6712

Mailing address

10645 Double R Blvd
Reno, NV 89521-8920
Phone (775) 852-6164

Other names 1

  • My Kid's 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

3150 Vista Blvd
Ste 110
Sparks, NV 89436
Phone (775) 852-6164

NPI Registry JSON

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

{
    "created_epoch": "1435104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435104000000",
    "number": "1073995213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10645 DOUBLE R BLVD",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895218920",
            "telephone_number": "775-852-6164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 VISTA BLVD",
            "address_2": "SUITE 110",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894366712",
            "telephone_number": "775-852-6164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN NEVADA DENTAL SPECIALTY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-24",
        "last_updated": "2015-06-24",
        "status": "A",
        "authorized_official_last_name": "CHRISTIANSEN",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "CHANNING",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "775-848-3005",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NV",
            "license": "4489",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NV",
            "license": "36-117",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Kid's Smile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sparks, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; 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.