West Edgewood Dental Small Smiles, LLC
NPI #1982827465 in Jefferson City, Missouri
Provider Information
- NPI Number
- 1982827465
- Entity Type
- Organization
- Organization Name
- West Edgewood Dental Small Smiles, LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Apr 11, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 3306 EMERALD LN
- City
- Jefferson City
- State
- Missouri
- ZIP Code
- 65109-6877
- Phone
- (573) 638-3897
Authorized Official
- Name
- RANDY BURROW
- Title
- OPERATIONS MANAGER
- Phone
- (573) 638-3897
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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