# STAR SMILES CHILDRENS DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518097153
- **Authorized official:** TIMOTHY A WILSON DDS (DENTIST)
- **Authorized official phone:** (702) 639-3515

## Contact information

- **Practice address:** 4040 NORTH MARTIN LUTHER KING BL, SUITE B, NORTH LAS VEGAS, NV 89032-3206
- **Practice address phone:** (702) 639-3515
- **Practice address fax:** (702) 639-3516
- **Mailing address:** 4040 NORTH MARTIN LUTHER KING BLVD., SUITE B, NORTH LAS VEGAS, NV 89032-6330
- **Mailing address phone:** (702) 639-3515
- **Mailing address fax:** (702) 639-3516

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 4522T | NV | Yes |

## Other

- **Enumeration date:** 03/06/2007
- **Last updated:** 04/04/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100502976 | — | NV |
| 05 | — | 100506669 | — | NV |