Individual
KELLI SIMONE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1630 MARKET CENTER BLVD FL 1, O FALLON, MO 63368-8407
(636) 300-4380
(636) 300-0073
Mailing address
1630 MARKET CENTER BLVD FL 1, O FALLON, MO 63368-8407
(636) 300-4380
(636) 300-0073
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2021022556
MO
Other
Enumeration date
06/17/2021
Last updated
06/17/2021
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