# SMILE SAFARI OF MISSOURI

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538622071
- **Authorized official:** BONNIE BRIZENDINE (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (614) 563-8681

## Contact information

- **Practice address:** 10016 E 63RD ST, RAYTOWN, MO 64133-5102
- **Practice address phone:** (816) 313-8485
- **Mailing address:** 1709 S MUR LEN RD, OLATHE, KS 66062-2611
- **Mailing address phone:** (913) 353-4001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/11/2019
- **Last updated:** 04/11/2019