Organization
LITTLE BIG SMILES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN G WILSON DDS (OWNER/DENTIST)
(970) 901-9865
Entity
Organization
Contact information
Practice address
9000 E 350, RAYTOWN, MO 64133-5717
(816) 674-9796
Mailing address
9000 E 350, RAYTOWN, MO 64133-5717
(816) 674-9796
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2010033385
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790905800
—
MO
Enumeration date
11/10/2015
Last updated
11/10/2015
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