WILD SMILES, LLC (NPI# 1295920346) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295920346 |
| Entity Type | Organization |
| Organization Name | WILD SMILES, LLC |
| Other Organization Name | PEDIATRIC DENTAL OF LEXINGTON |
| Practice Address |
203 North Lake Drive Lexington SC 29072 |
| Practice Telephone | 8033561606 |
| Practice Fax Number | 8033597542 |
| Mailing Telephone | 8033561606 |
| Mailing Fax Number | 8033597542 |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2010-12-16 |
| Authorized Official Name | MRS. DONNA M. BABCOCK (INSURANCE COORDINATOR) |
| Authorized Official Telephone | 8033561606 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
3351 | SC | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
SC3351 | SC | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | NPI | 1720106610 | 01 |
| SC | ZX3864 | 05 | |
| SC | Z33517 | 05 | |
| SC | NPI | 1275696023 | 01 |
| Other Name | Type Code |
|---|---|
| Pediatric Dental of Lexington | Former Legal Business Name - Organization |
| Street Address |
203 NORTH LAKE DRIVE |
| City | LEXINGTON |
| State | SC |
| Zip Code | 29072 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700484821 | Grace Physicians Services | Clinic/Center | 1483 Old Cherokee Road, Lexington, SC 29072 | 2020-10-12 |
| 1750995007 | Trinity Health and Wellness | Clinic/Center | 1483 Old Cherokee Rd, Lexington, SC 29072 | 2020-09-03 |
| 1730727629 | Erika Watts | Occupational Therapist | 100 Tarrar Springs Road, Sped, Lexington, SC 29072 | 2019-12-11 |
| 1194380600 | Lexington County Health Services District, Inc. | Clinic/Center | 154 Saluda Pointe Ct, Lexington, SC 29072 | 2019-05-09 |
| 1962973768 | William R. Key | Counselor | Lexington Community Mental Health Center, 301 Palmetto Park Boulevard, Lexington, SC 29072 | 2018-12-06 |
| 1639651961 | Lindsey Terry | Social Worker | 108 Palmetto Pk. Boulveard, Suite D, Lexington, SC 29072 | 2018-09-04 |
| 1922594126 | Dental Professional of South Carolina, P.C. | Dentist | 2448 Augusta Hwy, Lexington, SC 29072 | 2018-07-11 |
| 1598251605 | Lynn Marceline Beckett-lowe | Nurse Practitioner | 124 Pink Camellia Lane, Lexington, SC 29072 | 2018-07-02 |
| 1083120620 | Diana Reiss | Counselor | 714 S Lake Drive, 120, Lexington, SC 29072 | 2017-12-19 |
| 1649781857 | Constance Jean Lynch | Occupational Therapist | 800 North Lake Boulevard, Lexington, SC 29072 | 2017-10-14 |
| Find all providers in zip 29072 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164876280 | Kyle Clayton Kirk | Dentist | 2517 Sir Barton Way # 200, Lexington, KY 40509 | 2016-04-14 |
| 1528429644 | Stephanie Silva | Dentist | 5080 Sunset Blvd Ste B, Lexington, SC 29072-7051 | 2016-03-16 |
| 1841667037 | Midlands Pediatric Dentistry LLC | Dentist | 253 Cedarcrest Dr, Lexington, SC 29072-3812 | 2015-08-24 |
| 1639571607 | Sunset Children's Dentistry | Dentist | 5080 Sunset Blvd, Suite B, Lexington, SC 29072-7051 | 2014-09-22 |
| 1043655392 | Emilee Young Sexton | Dentist | 2549 Sun Seeker Ct, Lexington, KY 40503-2980 | 2013-04-30 |
| 1639361785 | Daniel John Steckler | Dentist | Ky Clinic Dentistry, Room A-219, Lexington, KY 40536-0001 | 2007-08-13 |
| 1699975904 | Justin C. Clemens | Dentist | 620 Perimeter Dr., Suite 103, Lexington, KY 40517 | 2007-07-24 |
| 1417078726 | Tommy Christopher Burke | Dentist | 10855 Highway 412 W, Lexington, TN 38351-6283 | 2007-04-03 |
| 1699819524 | Dentistry for Children | Dentist | 216 Fountain Court, Suite 150, Lexington, KY 40509 | 2007-02-16 |
| 1164571782 | Ronald Lee Singer | Dentist | 740 S Limestone Uk College of Dentistry Ste A219, Lexington, KY 40536-4495 | 2007-01-10 |
| Find all providers in LEXINGTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.