NPIMap

Organization Active NPI

Kids Smiles

  • General Practice Dentistry
  • Philadelphia, PA
National Provider Identifier
1851432298
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS021445L Issued in PA
Legal business name
KIDS SMILES
Practice address
5828 Market St # B
Philadelphia, PA 19139-3114
Phone
(215) 747-6901
Fax
(215) 747-6907
NPI assigned
Feb 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Noni Mastra
Title
Financial Director
Phone
(215) 747-6901

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DS021445L PA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DS036815 PA

Addresses

Primary practice location

5828 Market St # B
Philadelphia, PA 19139-3114

Mailing address

5828 Market St # B
Philadelphia, PA 19139-3114
Phone (215) 747-6901

Other identifiers 1

IdentifierTypeStateIssuer
0018280190002MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Kids Smiles2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5828 Market St
Ste B
Philadelphia, PA 19139
Phone (215) 747-6901

Practitioners & affiliated clinicians

Practitioners 5

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": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851432298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5828 MARKET ST # B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191393114",
            "telephone_number": "215-747-6901",
            "fax_number": "215-747-6907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5828 MARKET ST # B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191393114",
            "telephone_number": "215-747-6901",
            "fax_number": "215-747-6907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MASTRA",
        "authorized_official_first_name": "NONI",
        "authorized_official_title_or_position": "FINANCIAL DIRECTOR",
        "authorized_official_telephone_number": "215-747-6901"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS021445L",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS036815",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018280190002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.