Star Smiles Childrens Dentistry

Primary specialty

DentistTaxonomy code 122300000X

License

4522T Issued in NV

Legal business name

STAR SMILES CHILDRENS DENTISTRY

Practice address

4040 North Martin Luther King BL
Suite B
North Las Vegas, NV 89032-3206

Phone

(702) 639-3515

Fax

(702) 639-3516

NPI assigned

Mar 6, 2007

Organization subpart

No

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

Authorized official

Name

Timothy A Wilson, DDS

Title

Dentist

Phone

(702) 639-3515

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333497600000",
    "number": "1518097153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 NORTH MARTIN LUTHER KING BLVD.",
            "address_2": "SUITE B",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890326330",
            "telephone_number": "702-639-3515",
            "fax_number": "702-639-3516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 NORTH MARTIN LUTHER KING BL",
            "address_2": "SUITE B",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890323206",
            "telephone_number": "702-639-3515",
            "fax_number": "702-639-3516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR SMILES CHILDRENS DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2012-04-04",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "702-639-3515",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NV",
            "license": "4522T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100506669",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100502976",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christian Marcus Stanley
• Joshua S Stanley, PHARM D
• Terence Stanley Jr.
• Kaylon Njoli Eura Staples
• Star Horizon LLC
• Stargold Medic Transport Service
• Dawn L Starks-Ball, LCSW
• Kendric Rashaad Starling Sr.
• State of Nevada - Sncas Case Management (SNCAS Case Management)
• Anthony Markell Staten

• Dentist in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Dentist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.