Healthcare Provider Details

I. General information

NPI: 1225276090
Provider Name (Legal Business Name): BEST SMILE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2009
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 E 24 HWY
INDEPENDENCE MO
64050
US

IV. Provider business mailing address

651 E 24 HWY
INDEPENDENCE MO
64050
US

V. Phone/Fax

Practice location:
  • Phone: 816-461-0300
  • Fax: 816-461-3675
Mailing address:
  • Phone: 816-461-0300
  • Fax: 816-461-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2008028696
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CRAIG A BAHR
Title or Position: OWNER
Credential: DMD
Phone: 303-524-4500