Legendary Smiles Dental Group

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LEGENDARY SMILES DENTAL GROUP

Practice address

361 N Main St
Watford City, ND 58854-7311

Phone

(701) 842-4474

NPI assigned

Aug 19, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Monty Stewart Bulzomi, DDSNPI 1841619384

Title

Dentist

Phone

(701) 842-4474

Specialties & licenses 1

Addresses

Other names 1

• Legendary Smiles Doing business as

Practitioners 3

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

• Monty Bulzomi

  • Student in an Organized Health Care Education/Training Program
  • St Anthony, MN
  • NPI 1841619384
  NPD Authorized official
• Nathan Joseph Burbach, DDS

  • Dentist
  • Watford City, ND
  • NPI 1093129512
  NPD
• Danielle Mari Demorrow, DDS

  • Dentist
  • Watford City, ND
  • NPI 1437688132
  NPD

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

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1104658079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 486",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588540486",
            "telephone_number": "701-842-4474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "361 N MAIN ST",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588547311",
            "telephone_number": "701-842-4474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGENDARY SMILES DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "BULZOMI",
        "authorized_official_first_name": "MONTY",
        "authorized_official_middle_name": "STEWART",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "701-842-4474",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legendary Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Lynn Klein, D.C.
• Kara Lynn Marie Langowski
• Larsen Service Drug Inc
• Larry C. Larsen, R.PH.
• John Larson
• Legendary Smiles, P.C.
• Lev3L Performance Physical Therapy
• Kelsey Nicole Linseth, PHARM D
• Claudia H Low, APRN, ACNS-BC
• Maisey Dental

• Dental Clinic/Center in Watford City, ND
• Providers in Watford City, ND by specialty
• Dental Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; 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.