Organization
ALL ABOUT SMILES LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LORIN G VAN DRIE (OWNER)
(417) 234-3305
Entity
Organization
Contact information
Practice address
1717 E CHEROKEE ST, SUITE 104, SPRINGFIELD, MO 65804-2335
(417) 889-5757
(417) 889-5758
Mailing address
1717 E CHEROKEE ST, SUITE 104, SPRINGFIELD, MO 65804-2335
(417) 889-5757
(417) 889-5758
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
012493
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669574935
—
MO
05
—
1841511805
—
MO
Enumeration date
06/15/2012
Last updated
06/15/2012
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