Smiles 4 Kids, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8630 Issued in CO

Legal business name

SMILES 4 KIDS, LLC

Practice address

4337 E Main St
Ste 205
Farmington, NM 87402-8633

Phone

(970) 247-0202

NPI assigned

Mar 28, 2012

Organization subpart

No

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

Authorized official

Name

Dr. J Ryan Mickelson

Title

President

Phone

(970) 247-0174

Specialties & licenses 1

Addresses

Other names 1

• Smiles 4 Kids Doing business as

Locations

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

{
    "created_epoch": "1332892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332892800000",
    "number": "1346516929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4337 E MAIN ST",
            "address_2": "STE 205",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874028633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4337 E MAIN ST",
            "address_2": "STE 205",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874028633",
            "telephone_number": "970-247-0202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILES 4 KIDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-28",
        "last_updated": "2012-03-28",
        "status": "A",
        "authorized_official_last_name": "MICKELSON",
        "authorized_official_first_name": "J",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "970-247-0174",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "8630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smiles 4 Kids",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Farmington, NM
• Providers in Farmington, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.