Kids Little Smiles Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4688 Issued in AZ

Legal business name

KIDS LITTLE SMILES DENTISTRY

Practice address

2202 Hualapai Mountain Rd Ste 201
Kingman, AZ 86401-8337

Phone

(928) 718-7645

Fax

(928) 718-7655

NPI assigned

Dec 29, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Charles J. Lucero, D.D.SNPI 1710988787

Title

General Dentist

Phone

(928) 718-7645

Specialties & licenses 4

Addresses

Other names 1

• Kids Little Smiles Dentistry Other name

Locations

Practitioners 1

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.

• Charles Joseaph Lucero, DDS

  • General Practice Dentistry
  • Kingman, AZ
  • NPI 1710988787
  NPD (past) Authorized official

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

{
    "created_epoch": "1230508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230508800000",
    "number": "1225274087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 HUALAPAI MOUNTAIN RD STE 201",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864018337",
            "telephone_number": "928-718-7645",
            "fax_number": "928-718-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 HUALAPAI MOUNTAIN RD STE 201",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864018337",
            "telephone_number": "928-718-7645",
            "fax_number": "928-718-7655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS LITTLE SMILES DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-29",
        "last_updated": "2008-12-29",
        "status": "A",
        "authorized_official_last_name": "LUCERO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "928-718-7645",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D4688",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D5580",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D7582",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "D5432",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids Little Smiles Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Steven Kemp, FNP APPLICANT
• Jennifer Ann Kern, FNP
• Ahmad Saeed Khan, M.D.
• Mahmood Khan, M.D.
• Muhammad Azam Khan, MD
• Yong Chan Kim, M.D.
• Theodore S Kimball III, DDS
• Lewis Miller King III, BA
• Kingman Academy of Learning
• Kingman Behavioral Health LLC (Hickory Behavioral Center at Kingman)

• General Practice Dentistry in Kingman, AZ
• Providers in Kingman, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2008; 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.