NPIMap

Organization Active NPI

Smile Burns

  • Dental Clinic/Center
  • Burns, OR
National Provider Identifier
1326858119
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SMILE BURNS
Doing business as
Dr. Kelley Mingus
Practice address
711 Ponderosa VLG
Burns, OR 97720-2315
Phone
(541) 589-4202
NPI assigned
Jan 13, 2025
Organization subpart
Yes
Parent organization
DR. KELLEY MINGUSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Authorized official

Name
Dr. Kelley Ray Mingus, DMDNPI 1447259262
Title
Owner
Phone
(541) 382-6565

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

711 Ponderosa VLG
Burns, OR 97720-2315

Mailing address

711 Ponderosa VLG
Burns, OR 97720-2315
Phone (541) 589-4202

Other practice location 1

225 Scalehouse Loop
Bend, OR 97702-1272
Phone (541) 382-6565

Other names 1

  • Dr. Kelley Mingus Doing business as

National Provider Directory

National Provider Directory
Part of
Smile Burns

Locations

225 Scalehouse Loop
Bend, OR 97702
Phone (541) 382-6565

711 Ponderosa Vlg
Burns, OR 97720
Phone (541) 589-4202

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1326858119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 PONDEROSA VLG",
            "city": "BURNS",
            "state": "OR",
            "postal_code": "977202315",
            "telephone_number": "541-589-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 PONDEROSA VLG",
            "city": "BURNS",
            "state": "OR",
            "postal_code": "977202315",
            "telephone_number": "541-589-4202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 Scalehouse Loop",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977021272",
            "country_code": "US",
            "telephone_number": "541-382-6565",
            "fax_number": "541-382-6776",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SMILE BURNS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DR. KELLEY MINGUS",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "MINGUS",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-382-6565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Kelley Mingus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burns, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.