Organization
KIDS LITTLE SMILES DENTISTRY
Active
Other names
Kids Little Smiles Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES J. LUCERO D.D.S (GENERAL DENTIST)
(928) 718-7645
Entity
Organization
Contact information
Practice address
2202 HUALAPAI MOUNTAIN RD STE 201, KINGMAN, AZ 86401-8337
(928) 718-7645
(928) 718-7655
Mailing address
2202 HUALAPAI MOUNTAIN RD STE 201, KINGMAN, AZ 86401-8337
(928) 718-7645
(928) 718-7655
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4688
AZ
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
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