Organization
BOLIVAR SMILES DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD LOUIS GUERRA DMD (OWNER)
(417) 326-3537
Entity
Organization
Contact information
Practice address
1300 N OAKLAND AVE STE B, BOLIVAR, MO 65613-3008
(417) 326-6061
(417) 326-3537
Mailing address
1300 N OAKLAND AVE STE B, BOLIVAR, MO 65613-3008
(417) 326-6061
(417) 326-3537
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14888370
CAQH NUMBER
—
01
—
2009015933
STATE LINCENSE
MO
Enumeration date
07/18/2022
Last updated
03/07/2023
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