NPIMap

Organization Active NPI

Northern Nevada Dental Specialties Group

Doing business as My Kid's Smile

  • Pediatric Dentistry
  • Reno, NV
National Provider Identifier
1720346117
Registry record updated Nov 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
S6-20 Issued in NV
Legal business name
NORTHERN NEVADA DENTAL SPECIALTIES GROUP
Doing business as
My Kid's Smile
Practice address
10645 Double R Blvd
Reno, NV 89521-8920
Phone
(775) 852-6164
Fax
(775) 284-7352
NPI assigned
Apr 24, 2012
Last updated
Nov 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2014

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

Authorized official

Name
Dr. J Justin Wilkerson, DDSNPI 1205976719
Title
Manager
Phone
(775) 823-9797

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 Dentistry 1223P0221X S6-20 NV Primary

Addresses

Primary practice location

10645 Double R Blvd
Reno, NV 89521-8920

Mailing address

10645 Double R Blvd
Reno, NV 89521-8920
Phone (775) 852-6164

Other names 1

  • My Kid's Smile Doing business as

National Provider Directory

National Provider Directory
Tax ID family
My Kid's Smile4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the 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, 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": "1335225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415145600000",
    "number": "1720346117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10645 DOUBLE R BLVD",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895218920",
            "telephone_number": "775-852-6164",
            "fax_number": "775-284-7352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10645 DOUBLE R BLVD",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895218920",
            "telephone_number": "775-852-6164",
            "fax_number": "775-284-7352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN NEVADA DENTAL SPECIALTIES GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-24",
        "last_updated": "2014-11-05",
        "status": "A",
        "authorized_official_last_name": "WILKERSON",
        "authorized_official_first_name": "J",
        "authorized_official_middle_name": "JUSTIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "775-823-9797",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NV",
            "license": "S6-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Kid's Smile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2014; 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.