Provider Demographics
NPI:1316638125
Name:CCS SMILES LLC
Entity type:Organization
Organization Name:CCS SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-960-5740
Mailing Address - Street 1:11941 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4502
Mailing Address - Country:US
Mailing Address - Phone:314-501-8300
Mailing Address - Fax:
Practice Address - Street 1:11941 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-4502
Practice Address - Country:US
Practice Address - Phone:314-501-8300
Practice Address - Fax:314-462-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty