NPIMap

Organization Active NPI

Maverick Smiles, LLC

  • Dental Clinic/Center
  • Mauldin, SC
National Provider Identifier
1689227381
Registry record updated May 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
MAVERICK SMILES, LLC
Practice address
20 Owens LN
Mauldin, SC 29662-2634
Phone
(864) 243-8593
NPI assigned
Jul 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2025

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

Authorized official

Name
Mary Alice Vickery Hughes, DMDNPI 1942565023
Title
Owner
Phone
(864) 414-5918

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

20 Owens LN
Mauldin, SC 29662-2634

Mailing address

20 Owens LN
Mauldin, SC 29662-2634
Phone (864) 243-8593

Other practice location 1

101 Milacron Drive
Fountain Inn, SC 29644
Phone (864) 243-8593

Other names 1

  • Maverick Smiles Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

117 S Main St
Mauldin, SC 29662

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": "1563753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748390400000",
    "number": "1689227381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 OWENS LN",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296622634",
            "telephone_number": "864-243-8593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 OWENS LN",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296622634",
            "telephone_number": "864-243-8593"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Milacron Drive",
            "address_purpose": "LOCATION",
            "city": "Fountain Inn",
            "state": "SC",
            "postal_code": "29644",
            "country_code": "US",
            "telephone_number": "864-243-8593",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAVERICK SMILES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-22",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-14",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "MARY ALICE",
        "authorized_official_middle_name": "VICKERY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-414-5918",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maverick Smiles Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maverick Smiles Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mauldin, SC

Sources for this page

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