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General NPI Number Information
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NPI Number | 1861725236
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Entity Type | Organization
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Legal Business Name | GIVE KIDS A SMILE, INC
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 340 MID RIVERS MALL DR STE A
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City | SAINT PETERS
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State | MO
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Zip | 63376-1581
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Country | US
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Telephone | 636-397-6453
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Fax | 163-627-8267
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Provider Business Mailing Address
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Address Line | 340 MID RIVERS MALL DR STE A
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City | SAINT PETERS
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State | MO
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Zip | 63376-1581
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Country | US
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Telephone | 636-397-6453
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Fax | 163-627-8267
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS C FLAVIN
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Credential | DDS
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Telephone | 636-397-6453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1347
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License Number State | MO
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