Healthcare Provider Details

I. General information

NPI: 1669262150
Provider Name (Legal Business Name): BRANSON KIDS DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 HWY 248 STE 515
BRANSON MO
65616-3804
US

IV. Provider business mailing address

1531 E SUNSHINE ST STE E10
SPRINGFIELD MO
65804-1237
US

V. Phone/Fax

Practice location:
  • Phone: 417-883-5866
  • Fax:
Mailing address:
  • Phone: 417-883-5866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER T HUDKINS
Title or Position: OWNER
Credential: DDS
Phone: 417-243-0020