# MISSOURI CENTER FOR ORAL SURGERY AND IMPLANTS LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KENNETH CLARK PRIDDY, DDS, MD, PC
- **Other names:** Oral and Maxillofacial Surgery at the Crossing, Kelsey Smith, DDS, MD, PC, First Capitol Oral and Maxillofacial Surgery
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1447962915
- **Legal business name:** KENNETH CLARK PRIDDY, DDS, MD, PC
- **Authorized official:** DR. KELSEY CAITLIN SMITH DDS, MD (PARTNER)
- **Authorized official phone:** (314) 956-5651

## Contact information

- **Practice address:** 853 MEDICAL DR STE 115, WENTZVILLE, MO 63385-3825
- **Practice address phone:** (636) 887-3100
- **Practice address fax:** (636) 887-3102
- **Mailing address:** 1 MID RIVERS MALL DR STE 310, SAINT PETERS, MO 63376-4323
- **Mailing address phone:** (636) 928-7217
- **Mailing address fax:** (636) 397-0223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 12/15/2022
- **Last updated:** 03/27/2023