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General NPI Number Information
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NPI Number | 1174891022
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Entity Type | Organization
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Legal Business Name | UPWARD SMILES,INC
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 2820 ANCHOR DR
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City | FARMINGTON
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State | MO
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Zip | 63640-7387
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Country | US
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Telephone | 573-327-8010
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Fax | 573-358-5941
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Provider Business Mailing Address
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Address Line | 2820 ANCHOR DR
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City | FARMINGTON
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State | MO
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Zip | 63640-7387
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Country | US
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Telephone | 573-327-8010
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Fax | 573-358-5941
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. SHERRY LYNN CAULEY
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Credential |
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Telephone | 573-327-8010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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