NPIMap

Organization Active NPI

Waggoner Professional Services PC

Doing business as Galaxy Smiles

  • Pediatric Dentistry
  • Las Vegas, NV
National Provider Identifier
1295259760
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
S6-17
Legal business name
WAGGONER PROFESSIONAL SERVICES PC
Doing business as
Galaxy Smiles
Practice address
9575 W Tropicana Ave Ste 5
Las Vegas, NV 89147-8491
Phone
(702) 633-8331
NPI assigned
Jul 27, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Lisa Antuna
Title
Practice Manager
Phone
(702) 254-4220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X S6-17 Primary

Addresses

Primary practice location

9575 W Tropicana Ave Ste 5
Las Vegas, NV 89147-8491

Mailing address

9575 W Tropicana Ave Ste 5
Las Vegas, NV 89147-8491
Phone (702) 633-8331

Other names 1

  • Galaxy Smiles Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1295259760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9575 W TROPICANA AVE STE 5",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891478491",
            "telephone_number": "702-633-8331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9575 W TROPICANA AVE STE 5",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891478491",
            "telephone_number": "702-633-8331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGGONER PROFESSIONAL SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-27",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ANTUNA",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "702-254-4220"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": "S6-17",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Galaxy Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.