Organization
SMILE CLUBHOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRENT DUANE MADSEN DMD (OWNER)
(480) 789-9554
Entity
Organization
Contact information
Practice address
2910 E BATTLEFIELD ST, SPRINGFIELD, MO 65804-4016
(417) 444-6776
Mailing address
2910 E BATTLEFIELD ST, SPRINGFIELD, MO 65804-4016
(417) 444-6776
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400111093
—
MO
Enumeration date
10/14/2022
Last updated
10/14/2022
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