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General NPI Number Information
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NPI Number | 1952715971
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Entity Type | Organization
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Legal Business Name | LITTLE URBAN SMILES
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 1301 N KINGSHIGHWAY BLVD STE 2
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City | SAINT LOUIS
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State | MO
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Zip | 63113-1408
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Country | US
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Telephone | 314-367-1434
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 N KINGSHIGHWAY BLVD STE 2
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City | SAINT LOUIS
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State | MO
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Zip | 63113-1408
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Country | US
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Telephone | 314-367-1434
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TALISA K GLOVER
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Credential | R.D.H.
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Telephone | 314-367-1434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 003732
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License Number State | MO
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