Organization
BROADWAY SMILES DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACI NICOLE OSGOOD DDS (GENERAL DENTIST)
(913) 558-3919
Entity
Organization
Contact information
Practice address
2016 S BROADWAY # 8439, OAK GROVE, MO 64075-8439
(816) 690-7757
Mailing address
6724 E 134TH ST, GRANDVIEW, MO 64030-3236
(913) 558-3919
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/16/2021
Last updated
04/16/2021
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