Provider Demographics
NPI:1124398425
Name:SIMPLY SMILES FAMILY DENTAL, LLC
Entity type:Organization
Organization Name:SIMPLY SMILES FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:BUDD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-732-6785
Mailing Address - Street 1:1093 US HIGHWAY 60 E
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1570
Mailing Address - Country:US
Mailing Address - Phone:417-732-6785
Mailing Address - Fax:417-732-6411
Practice Address - Street 1:1093 US HIGHWAY 60 E
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1570
Practice Address - Country:US
Practice Address - Phone:417-732-6785
Practice Address - Fax:417-732-6411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental