# WILD SMILES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pediatric Dental of Lexington
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295920346
- **Authorized official:** MRS. DONNA M. BABCOCK (INSURANCE COORDINATOR)
- **Authorized official phone:** (803) 356-1606

## Contact information

- **Practice address:** 203 NORTH LAKE DRIVE, LEXINGTON, SC 29072
- **Practice address phone:** (803) 356-1606
- **Practice address fax:** (803) 359-7542
- **Mailing address:** 203 NORTH LAKE DRIVE, LEXINGTON, SC 29072
- **Mailing address phone:** (803) 356-1606
- **Mailing address fax:** (803) 359-7542

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 3351 | SC | — |
| 1223P0221X | Pediatric Dentistry | SC3351 | SC | Yes |

## Other

- **Enumeration date:** 09/12/2007
- **Last updated:** 12/16/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1275696023 | NPI | SC |
| 01 | — | 1720106610 | NPI | SC |
| 05 | — | Z33517 | — | SC |
| 05 | — | ZX3864 | — | SC |