Healthcare Provider Details

I. General information

NPI: 1154675262
Provider Name (Legal Business Name): ARNOLD SMILES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 RICHARDSON XING
ARNOLD MO
63010-6023
US

IV. Provider business mailing address

124 RICHARDSON XING
ARNOLD MO
63010-6023
US

V. Phone/Fax

Practice location:
  • Phone: 636-464-6444
  • Fax:
Mailing address:
  • Phone: 636-464-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2003013103
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN MARISCAL
Title or Position: OWNER
Credential: DDS
Phone: 636-464-6444