MEDICARE: MIGHTY SMILES DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1669048526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIGHTY SMILES DENTISTRY

Provider Business Mailing Address
First Line	:	1220 SHADOW LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2414
Country	:	US
Telephone Number	:	303-319-2288
Fax Number	:

Provider Business Practice Location Address
First Line	:	4210 W CRAIG RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2734
Country	:	US
Telephone Number	:	702-929-2022
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. AMANDA CAMPBELL
Credential	:	DDS
Telephone Number	:	303-319-2288

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	06/01/2021

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Directions to “MIGHTY SMILES DENTISTRY ” Practice Location

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