Organization
SMILE UP DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY LEE (OWNER/DENTIST)
(417) 494-5017
Entity
Organization
Contact information
Practice address
708 W MOUNT VERNON ST, NIXA, MO 65714-9682
(417) 494-5017
Mailing address
708 W MOUNT VERNON ST, NIXA, MO 65714-9682
(417) 494-5017
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/17/2018
Last updated
10/17/2018
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