Provider Demographics
NPI:1104657055
Name:SMILE CLUBHOUSE OZARK LLC
Entity type:Organization
Organization Name:SMILE CLUBHOUSE OZARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-551-9998
Mailing Address - Street 1:1427 W STATE HIGHWAY J
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7473
Mailing Address - Country:US
Mailing Address - Phone:417-551-9998
Mailing Address - Fax:417-551-9997
Practice Address - Street 1:1427 W STATE HIGHWAY J
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7473
Practice Address - Country:US
Practice Address - Phone:417-444-6776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty