Organization
WEST EDGEWOOD DENTAL SMALL SMILES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY BURROW (OPERATIONS MANAGER)
(573) 638-3897
Entity
Organization
Contact information
Practice address
3306 EMERALD LN, JEFFERSON CITY, MO 65109-6877
(573) 638-3897
(573) 761-0515
Mailing address
3306 EMERALD LN, JEFFERSON CITY, MO 65109-6877
(573) 638-3897
(573) 761-0515
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12095
MO
Other
Enumeration date
04/11/2007
Last updated
08/22/2020
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