Organization
SMILESHACK MISSOURI, LLC
Active
Other names
SmileShack
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES BALLOU DDS (OWNER)
(972) 672-9279
Entity
Organization
Contact information
Practice address
9105 E 350, RAYTOWN, MO 64133-5718
(816) 533-6819
Mailing address
9105 E 350, RAYTOWN, MO 64133-5718
(816) 533-6819
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
12/29/2021
Last updated
12/29/2021
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