Koolsmiles Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KOOLSMILES DENTAL CORPORATION

Practice address

1975 W Craig Rd Ste 103
North Las Vegas, NV 89032-0332

Phone

(702) 220-4266

NPI assigned

Jun 6, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Derrick Pham, DDSNPI 1588011373

Title

President

Phone

(714) 417-0246

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Derrick Tuan Pham, D.D.S

  • General Practice Dentistry
  • Huntington Beach, CA
  • NPI 1588011373
  NPD Authorized official
• Song Ha Nguyen

  • General Practice Dentistry
  • North Las Vegas, NV
  • NPI 1275201188
  NPD (past)

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

{
    "created_epoch": "1622937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622937600000",
    "number": "1972170389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5947 AZZURA PALMS AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891396968",
            "telephone_number": "714-417-0246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 W CRAIG RD STE 103",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890320332",
            "telephone_number": "702-220-4266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOLSMILES DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-06",
        "last_updated": "2021-06-06",
        "certification_date": "2021-06-06",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-417-0246",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khali Koetting
• Alec Kolbasky
• Ramanujam Vijaya Komanduri, MD
• Komfort Kare
• Alexander Koo, PHARMD
• Marek Korzeniowski, MD
• Shoshanna Koszer, MS
• Mikayla Hope Kotter, APRN
• Dexter Kountz
• Toni Kovach, NBHWC

• General Practice Dentistry in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2021; 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.