MEDICARE: PEDIATRIC SMILES, LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1942733571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC SMILES, LLC

Provider Business Mailing Address
First Line	:	8672 NE FLINTLOCK RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64157-1087
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8672 NE FLINTLOCK RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64157-1087
Country	:	US
Telephone Number	:	415-572-3471
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. RYAN ANDREW FRANCOIS
Credential	:	D.D.S.
Telephone Number	:	415-572-3471

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	04/11/2017

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