# WILD WEST KIDS DENTAL BULLHEAD

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

## Provider details

- **NPI number:** 1932799053
- **Authorized official:** DR. RONALD A DICARLO II DMD (OWNER)
- **Authorized official phone:** (928) 718-7188

## Contact information

- **Practice address:** 2401 MIRACLE MILE, BULLHEAD CITY, AZ 86442-7311
- **Practice address phone:** (928) 704-5573
- **Mailing address:** 2401 N STOCKTON HILL RD STE 1, KINGMAN, AZ 86401-4189
- **Mailing address phone:** (928) 718-7188

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/22/2021
- **Last updated:** 01/22/2021