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General NPI Number Information
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NPI Number | 1376061028
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Entity Type | Organization
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Legal Business Name | FRESH SMILES, LLC
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6060 TELEGRAPH RD STE H
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City | SAINT LOUIS
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State | MO
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Zip | 63129-4762
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Country | US
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Telephone | 314-846-1480
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Fax |
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Provider Business Mailing Address
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Address Line | 6060 TELEGRAPH RD STE H
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City | SAINT LOUIS
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State | MO
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Zip | 63129-4762
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Country | US
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Telephone | 314-846-1480
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ANWAR ABDUL-NABI
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Credential | DMD
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Telephone | 314-846-1480
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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 | 2015002919
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License Number State | MO
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