Provider Demographics
NPI:1033804364
Name:CHANGING SMILES PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:CHANGING SMILES PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEADS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-281-1922
Mailing Address - Street 1:10476 KIMBERTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-6748
Mailing Address - Country:US
Mailing Address - Phone:702-281-1922
Mailing Address - Fax:
Practice Address - Street 1:1750 WHEELER PEAK DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2150
Practice Address - Country:US
Practice Address - Phone:702-281-1922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty