Organization
ADMIRE YOUR SMILE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COREY MACK DDS (OWNER/DENTIST)
(620) 240-0565
Entity
Organization
Contact information
Practice address
1600 B SOUTHWEST BLVD, JEFFERSON CITY, MO 65109
(573) 635-4852
(573) 635-1167
Mailing address
1600 SOUTHWEST BLVD, SUITE B, JEFFERSON CITY, MO 65109
(573) 635-4852
(573) 635-1167
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/07/2024
Last updated
03/07/2024
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