# KIDS LITTLE SMILES DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kids Little Smiles Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225274087
- **Authorized official:** DR. CHARLES J. LUCERO D.D.S (GENERAL DENTIST)
- **Authorized official phone:** (928) 718-7645

## Contact information

- **Practice address:** 2202 HUALAPAI MOUNTAIN RD STE 201, KINGMAN, AZ 86401-8337
- **Practice address phone:** (928) 718-7645
- **Practice address fax:** (928) 718-7655
- **Mailing address:** 2202 HUALAPAI MOUNTAIN RD STE 201, KINGMAN, AZ 86401-8337
- **Mailing address phone:** (928) 718-7645
- **Mailing address fax:** (928) 718-7655

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D4688 | AZ | Yes |
| 1223G0001X | General Practice Dentistry | D5580 | AZ | — |
| 1223G0001X | General Practice Dentistry | D7582 | AZ | — |
| 1223P0221X | Pediatric Dentistry | D5432 | AZ | — |

## Other

- **Enumeration date:** 12/29/2008
- **Last updated:** 12/29/2008