Provider Demographics
NPI:1841349891
Name:CHILDRENS SMILE CENTER
Entity type:Organization
Organization Name:CHILDRENS SMILE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLSAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-582-5439
Mailing Address - Street 1:601 603 NORTH 21ST STREET
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721
Mailing Address - Country:US
Mailing Address - Phone:417-582-5439
Mailing Address - Fax:417-485-5455
Practice Address - Street 1:601 603 NORTH 21ST STREET
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721
Practice Address - Country:US
Practice Address - Phone:417-582-5439
Practice Address - Fax:417-485-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty