MEDICARE: GREATSMILES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	14467	MO

General Provider Information

NPI Number	:	1558516120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATSMILES, INC.

Provider Business Mailing Address
First Line	:	75 ELLIS AVE
Second Line	:
City	:	TROY
State	:	MO
Zip	:	63379-1151
Country	:	US
Telephone Number	:	636-528-6820
Fax Number	:	636-462-3226

Provider Business Practice Location Address
First Line	:	75 ELLIS AVE
Second Line	:
City	:	TROY
State	:	MO
Zip	:	63379-1151
Country	:	US
Telephone Number	:	636-528-6820
Fax Number	:	636-462-3226

Authorized Official
Title or Position	:	FINANCIAL COORDINATOR
Name	:	JENNIFER L ZORICH
Credential	:
Telephone Number	:	636-528-6820

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	04/30/2026

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Directions to “GREATSMILES, INC. ” Practice Location

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