NPIMap

Organization Active NPI

Great Smiles Dental Group

  • Dentist
  • Matthews, NC
National Provider Identifier
1548615511
Registry record updated Aug 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7424 Issued in NC
Legal business name
GREAT SMILES DENTAL GROUP
Practice address
15060 Idlewild Rd
St F
Matthews, NC 28104-3602
Phone
(704) 893-0351
Fax
(704) 893-0354
NPI assigned
Apr 27, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2016

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

Authorized official

Name
Mitesh B Dhulab, DMDNPI 1275558504
Title
Owner
Phone
(704) 893-0351

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 7424 NC Primary

Addresses

Primary practice location

15060 Idlewild Rd
St F
Matthews, NC 28104-3602

Mailing address

15060 Idlewild Rd
St F
Matthews, NC 28104-3602
Phone (704) 893-0351

National Provider Directory

National Provider Directory

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": "1461715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470787200000",
    "number": "1548615511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15060 IDLEWILD RD",
            "address_2": "ST F",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281043602",
            "telephone_number": "704-893-0351",
            "fax_number": "704-893-0354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15060 IDLEWILD RD",
            "address_2": "ST F",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281043602",
            "telephone_number": "704-893-0351",
            "fax_number": "704-893-0354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT SMILES DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-27",
        "last_updated": "2016-08-10",
        "status": "A",
        "authorized_official_last_name": "DHULAB",
        "authorized_official_first_name": "MITESH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-893-0351",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "7424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Matthews, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; 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.