Kids Dental Place

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

KIDS DENTAL PLACE

Doing business as

Crestview Wild Smiles

Practice address

101 4TH Ave Ste B
Crestview, FL 32539-2401

Phone

(850) 384-9171

NPI assigned

Apr 12, 2023

Last updated

Apr 12, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

KIDS DENTAL PLACEAs reported in NPPES

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

Authorized official

Name

Dr. Rachel WitcherNPI 1417300336

Title

Owner/Doctor

Phone

(850) 477-1722

Specialties & licenses 1

Addresses

Other names 1

• Crestview Wild Smiles Doing business as

Part of

Kids Dental Place

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rachel Carrie Witcher, DMD

  • Pediatric Dentistry
  • Pensacola, FL
  • NPI 1417300336
  NPD Authorized official
• Lauren Simon Sejan, DMD

  • Pediatric Dentistry
  • Crestview, FL
  • NPI 1952984742
  NPD

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

{
    "created_epoch": "1681257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681257600000",
    "number": "1093401101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 E OLIVE RD STE B",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325147237",
            "telephone_number": "850-477-1722",
            "fax_number": "850-476-8108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 4TH AVE STE B",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325392401",
            "telephone_number": "850-384-9171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS DENTAL PLACE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIDS DENTAL PLACE",
        "enumeration_date": "2023-04-12",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A",
        "authorized_official_last_name": "WITCHER",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "850-477-1722",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crestview Wild Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anita F Kelley-Dukes, D.C.
• Lani Marie Kelly, RBT
• Madeline Grace Kendall, FNP
• Tonisha Kenty, LPN
• Melinda S Kidder, DHA, MSN, RN, CENP
• Kids Talk Place LLC
• Kids Talk Place, LLC Dba Pediatric Therapy Center
• Jennifer Kilgore
• Connie Rhoades Killam, APRN
• Kineticore Rehab Inc.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; 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.