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General NPI Number Information
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NPI Number | 1477210318
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Entity Type | Organization
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Legal Business Name | LITTLE SMILES OF DARDENNE PRAIRIE
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Dates
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Enumeration Date | 11/28/2021
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Last Update Date | 11/28/2021
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Provider Practice Location Address
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Address Line | 1031 RONDALE CT
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City | DARDENNE PRAIRIE
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State | MO
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Zip | 63368-7368
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Country | US
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Telephone | 636-379-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 RONDALE CT
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City | DARDENNE PRAIRIE
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State | MO
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Zip | 63368-7368
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Country | US
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Telephone | 636-379-1171
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. COREY HASTINGS
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Credential | DDS
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Telephone | 314-496-3562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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