Wild Smiles, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

SC3351 Issued in SC

Legal business name

WILD SMILES, LLC

Practice address

203 North Lake Drive
Lexington, SC 29072

Phone

(803) 356-1606

Fax

(803) 359-7542

NPI assigned

Sep 12, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Donna M. Babcock

Title

Insurance Coordinator

Phone

(803) 356-1606

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Pediatric Dental of Lexington Former legal business name

Practitioners 4

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

• Carly Vail Cotten, DMD

  • Pediatric Dentistry
  • Columbia, SC
  • NPI 1316612054
  NPD (past)
• Kathryn Rogers Sample, DMD

  • Dentist
  • Lexington, SC
  • NPI 1720106610
  NPD (past)
• Gunjit Rick Singh, DMD

  • Pediatric Dentistry
  • Lexington, SC
  • NPI 1275696023
  NPD (past)
• Marc Weber, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Baltimore, MD
  • NPI 1013425834
  NPD (past)

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292457600000",
    "number": "1295920346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 NORTH LAKE DRIVE",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "29072",
            "telephone_number": "803-356-1606",
            "fax_number": "803-359-7542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 NORTH LAKE DRIVE",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "29072",
            "telephone_number": "803-356-1606",
            "fax_number": "803-359-7542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD SMILES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-12",
        "last_updated": "2010-12-16",
        "status": "A",
        "authorized_official_last_name": "BABCOCK",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "803-356-1606",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "SC3351",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "3351",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1720106610",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1275696023",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX3864",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z33517",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dental of Lexington",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Emily Whitesell
• Christopher M Wicker, MD
• Lexi Widenhouse
• Farrah Wigand, RDN, LD, CSOWM
• Wild Smiles White Knoll Family Dentistry, LLC
• Garner Johnson Wild, MD
• Graham Leonard Wilde, PH.D.
• Melissa Rae Wilges
• Ashleigh Wilkes
• William a Wells MD LLC

• Pediatric Dentistry in Lexington, SC
• Providers in Lexington, SC by specialty
• Pediatric Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2010; 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.