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General NPI Number Information
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NPI Number | 1184986077
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Entity Type | Organization
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Legal Business Name | ALL ABOUT SMILES LC
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 1717 E CHEROKEE ST SUITE 104
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2335
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Country | US
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Telephone | 417-889-5757
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Fax | 417-889-5758
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Provider Business Mailing Address
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Address Line | 1717 E CHEROKEE ST SUITE 104
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2335
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Country | US
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Telephone | 417-889-5757
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Fax | 417-889-5758
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Authorized Official
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Title or Position | OWNER
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Name | MR. LORIN G VAN DRIE
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Credential |
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Telephone | 417-234-3305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 012493
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License Number State | MO
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