Organization
MISSOURI SMILES LLC
Active
Other names
TBD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE LISENBY DMD (DENTIST OWNER)
(573) 424-2067
Entity
Organization
Contact information
Practice address
3621 DISCOVERY PARKWAY, STE 101, COLUMBIA, MO 65201
(573) 424-2067
Mailing address
2102 PORT TOWNSEND CT, COLUMBIA, MO 65203-1014
(573) 424-2067
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/10/2023
Last updated
08/10/2023
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