Wichita Smiles

Primary specialty

DentistTaxonomy code 122300000X

License

30183 Issued in TX

Legal business name

WICHITA SMILES

Practice address

2120 Virginia Dr Ste a
Wichita Falls, TX 76309-4646

Phone

(940) 761-5979

Fax

(903) 465-1134

NPI assigned

Mar 30, 2016

Organization subpart

No

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

Authorized official

Name

Jeffrey Bullock Johnson, DDS

Title

Owner/Dentist

Phone

(940) 761-5979

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1780047522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 VIRGINIA DR STE A",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763094646",
            "telephone_number": "940-761-5979",
            "fax_number": "903-465-1134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 VIRGINIA DR STE A",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763094646",
            "telephone_number": "940-761-5979",
            "fax_number": "903-465-1134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICHITA SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-30",
        "last_updated": "2016-03-30",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "BULLOCK",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "940-761-5979",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "30183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wichita Heart and Vascular Center, PLLC
• Wichita Home Health Service, Inc.
• Wichita Medical Group PLLC
• Wichita Medical Management, LLC
• Wichita Smiles
• Wichita Valley Rehabilitation Hospital
• Julie Ann Wicker, OT
• Kayla Christina Lynn Widener
• Bryan Wieck
• Beverly A Wilbur, DO

• Dentist in Wichita Falls, TX
• Providers in Wichita Falls, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 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.