NPIMap

Organization Active NPI

Pediatric Smiles PLLC

Doing business as Pediatric Smiles of Orem

  • Pediatric Dentistry
  • Orem, UT
National Provider Identifier
1366711087
Registry record updated Dec 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
8012319 Issued in UT
Legal business name
PEDIATRIC SMILES PLLC
Doing business as
Pediatric Smiles of Orem
Practice address
167 N 400 W
Suite a-4
Orem, UT 84057-1909
Phone
(801) 224-0861
Fax
(801) 804-5899
NPI assigned
Dec 27, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2011

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

Authorized official

Name
Dr. Adam Nicholas Shepherd, DDSNPI 1306080353
Title
Owner/Member
Phone
(801) 224-0861

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 8012319 UT Primary

Addresses

Primary practice location

167 N 400 W
Suite a-4
Orem, UT 84057-1909

Mailing address

167 N 400 W
Suite a-4
Orem, UT 84057-1909
Phone (801) 224-0861

Other names 1

  • Pediatric Smiles of Orem Doing business as

National Provider Directory

National Provider Directory

Locations

167 N 400 W
Ste A4
Orem, UT 84057
Phone (801) 226-3302

Practitioners & affiliated clinicians

Practitioners 1

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": "1324944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324944000000",
    "number": "1366711087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "167 N 400 W",
            "address_2": "SUITE A-4",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840571909",
            "telephone_number": "801-224-0861",
            "fax_number": "801-804-5899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 N 400 W",
            "address_2": "SUITE A-4",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840571909",
            "telephone_number": "801-224-0861",
            "fax_number": "801-804-5899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SMILES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-27",
        "last_updated": "2011-12-27",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "18012240861",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "UT",
            "license": "8012319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Smiles of Orem",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orem, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2011; 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.