Lake Kiowa Smiles, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

25047 Issued in TX

Legal business name

LAKE KIOWA SMILES, PLLC

Practice address

100 Kiowa Dr W, Ste 200
Lake Kiowa, TX 76240-9502

Phone

(940) 612-1555

Fax

(940) 612-1565

NPI assigned

Aug 6, 2018

Organization subpart

No

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

Authorized official

Name

Benjamin Tyler Hill, DDS

Title

Owner

Phone

(940) 612-1555

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lake Kiowa Family Dental Doing business as

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

{
    "created_epoch": "1533513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533513600000",
    "number": "1952889404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KIOWA DR W, STE 200",
            "city": "LAKE KIOWA",
            "state": "TX",
            "postal_code": "762409502",
            "telephone_number": "940-612-1555",
            "fax_number": "940-612-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 KIOWA DR W, STE 200",
            "city": "LAKE KIOWA",
            "state": "TX",
            "postal_code": "762409502",
            "telephone_number": "940-612-1555",
            "fax_number": "940-612-1565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE KIOWA SMILES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-06",
        "last_updated": "2018-08-06",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "TYLER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "940-612-1555",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "25047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "20547",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Kiowa Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Friedrich, DC
• Hh4U LLC
• Jami a. Hamilton, DC, LLC
• Estella M Johnson
• Lake Kiowa Family Dental, PLLC
• Kristi Longley, M.ED., LPC
• Debra Winter McDonald, RN,LPC
• Holly Oliveira, FNP
• Jenna Potz-Nielsen
• Leslie Schachar, M.D.

• General Practice Dentistry in Lake Kiowa, TX
• Providers in Lake Kiowa, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2018; 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.