=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851219943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINDRED SMILES FAMILY DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2026
-----------------------------------------------------
Last Update Date | 07/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2250 HIGHWAY 95 STE 566
-----------------------------------------------------
City | BULLHEAD CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86442-9007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-763-8750
-----------------------------------------------------
Fax | 928-543-2005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 30060
-----------------------------------------------------
City | LAUGHLIN
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89028-0060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-763-8750
-----------------------------------------------------
Fax | 928-543-2005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | PAUL CHANG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 928-763-8750
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------