NPIMap

Organization Active NPI

Kids Smiles

  • General Practice Dentistry
  • Philadelphia, PA
National Provider Identifier
1326189820
Registry record updated May 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS035389 Issued in PA
Legal business name
KIDS SMILES
Practice address
2821 Island Ave
Suite 210
Philadelphia, PA 19153-2300
Phone
(215) 492-9291
Fax
(215) 492-5856
NPI assigned
Feb 9, 2007
Last updated
May 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2012

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

Authorized official

Name
Noni Mastra
Title
Financial Director
Phone
(215) 492-9291

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS035389 PA Primary
General Practice Dentistry 1223G0001X DS035558 PA
Pediatric Dentistry 1223P0221X PA

Addresses

Primary practice location

2821 Island Ave
Suite 210
Philadelphia, PA 19153-2300

Mailing address

2821 Island Ave
Suite 210
Philadelphia, PA 19153-2300
Phone (215) 492-9291

Other identifiers 1

IdentifierTypeStateIssuer
0018280190001MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Kids Smiles2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2821 Island Ave
Ste 210
Philadelphia, PA 19153
Phone (215) 492-9291

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1326189820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2821 ISLAND AVE",
            "address_2": "SUITE 210",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191532300",
            "telephone_number": "215-492-9291",
            "fax_number": "215-492-5856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 ISLAND AVE",
            "address_2": "SUITE 210",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191532300",
            "telephone_number": "215-492-9291",
            "fax_number": "215-492-5856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "MASTRA",
        "authorized_official_first_name": "NONI",
        "authorized_official_title_or_position": "FINANCIAL DIRECTOR",
        "authorized_official_telephone_number": "215-492-9291"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS035389",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS035558",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018280190001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; 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.