Designer Smiles LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DESIGNER SMILES LLC

Practice address

405 E 19TH St
Cheyenne, WY 82001-4643

Phone

(307) 343-5676

NPI assigned

Nov 13, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Chad Michael Clark, DDSNPI 1952050924

Title

President

Phone

(307) 240-9966

Specialties & licenses 1

Addresses

Practitioners 1

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

• Chad Michael Clark, DDS, MS, BS

  • Dentist
  • Riverton, WY
  • NPI 1952050924
  NPD Authorized official

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

{
    "created_epoch": "1699833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701388800000",
    "number": "1093589863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 MEADOWLARK LN",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825012214",
            "telephone_number": "307-343-5676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 E 19TH ST",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820014643",
            "telephone_number": "307-343-5676"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "604 Meadowlark Ln",
            "address_purpose": "LOCATION",
            "city": "Riverton",
            "state": "WY",
            "postal_code": "825012214",
            "country_code": "US",
            "telephone_number": "307-343-5676",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DESIGNER SMILES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-13",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "307-240-9966",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marianne Denton, FNP
• Department of Veterans Affairs Meds by Mail
• Kathleen Ann Derr, R.PH
• Anita Carolyn Deselms, FNP-BC
• Kirstin Jo Deselms, PHARM D
• Kelsey J Devereaux, DPT
• Lillian Regina Devine, NP-C
• Kanti Devkota, FNP
• Tracy Dicamillo, LPN
• Austin Robert Dickerson

• All providers in Cheyenne, WY
• General Practice Dentistry in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.