Healthcare Provider Details

I. General information

NPI: 1508409046
Provider Name (Legal Business Name): SMILE MORE, SMILE BETTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 S GLENSTONE AVE STE O
SPRINGFIELD MO
65804-1513
US

IV. Provider business mailing address

1722 S GLENSTONE AVE STE O
SPRINGFIELD MO
65804-1513
US

V. Phone/Fax

Practice location:
  • Phone: 417-248-1234
  • Fax: 417-248-1515
Mailing address:
  • Phone: 417-248-1234
  • Fax: 417-248-1515

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: MISOOK AN RISSLER
Title or Position: DENTIST, OWNER
Credential: DDS
Phone: 417-248-1234