Legendary Smiles Orthodontics LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

LEGENDARY SMILES ORTHODONTICS LLC

Practice address

5220 Neil Rd.
Ste. 110
Reno, NV 89502

Phone

(775) 336-1510

Fax

(775) 336-1510

NPI assigned

May 22, 2017

Organization subpart

No

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

Authorized official

Name

Nate Rockwell

Title

Manager

Phone

(775) 336-1510

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1114454097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 GRANT DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895095301",
            "telephone_number": "775-336-1510",
            "fax_number": "775-432-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5220 NEIL RD.",
            "address_2": "STE. 110",
            "city": "RENO",
            "state": "NV",
            "postal_code": "89502",
            "telephone_number": "775-336-1510",
            "fax_number": "775-336-1510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1130 N. Hills Blvd. Ste. 101",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "89506",
            "country_code": "US",
            "telephone_number": "775-336-1510",
            "fax_number": "775-336-1510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3150 Vista Blvd",
            "address_2": "Ste. 112",
            "address_purpose": "LOCATION",
            "city": "Sparks",
            "state": "NV",
            "postal_code": "894368950",
            "country_code": "US",
            "telephone_number": "775-336-1510",
            "fax_number": "775-432-6001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10645 Double R Blvd.",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "89521",
            "country_code": "US",
            "telephone_number": "775-336-1510",
            "fax_number": "775-336-1510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEGENDARY SMILES ORTHODONTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-22",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "ROCKWELL",
        "authorized_official_first_name": "NATE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "775-336-1510"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.