Provider Demographics
NPI:1447962915
Name:MISSOURI CENTER FOR ORAL SURGERY AND IMPLANTS LLC
Entity type:Organization
Organization Name:MISSOURI CENTER FOR ORAL SURGERY AND IMPLANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:CAITLIN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:314-956-5651
Mailing Address - Street 1:1 MID RIVERS MALL DR STE 310
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-4323
Mailing Address - Country:US
Mailing Address - Phone:636-928-7217
Mailing Address - Fax:636-397-0223
Practice Address - Street 1:853 MEDICAL DR STE 115
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3825
Practice Address - Country:US
Practice Address - Phone:636-887-3100
Practice Address - Fax:636-887-3102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNETH CLARK PRIDDY, DDS, MD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-15
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty