Healthcare Provider Details

I. General information

NPI: 1851219943
Provider Name (Legal Business Name): KINDRED SMILES FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HIGHWAY 95 STE 566
BULLHEAD CITY AZ
86442-9007
US

IV. Provider business mailing address

PO BOX 30060
LAUGHLIN NV
89028-0060
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-8750
  • Fax: 928-543-2005
Mailing address:
  • Phone: 928-763-8750
  • Fax: 928-543-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: PAUL CHANG
Title or Position: DOCTOR
Credential: DDS
Phone: 928-763-8750