Missouri Kids Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MISSOURI KIDS DENTAL LLC

Doing business as

Missouri Kids Dental

Practice address

732 S Range Line Rd Ste D
Joplin, MO 64801-5519

Phone

(480) 866-8811

NPI assigned

Nov 12, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Teresa Zwicky

Title

Credentialing Manager

Phone

(480) 866-8811

Specialties & licenses 1

Addresses

Other names 1

• Missouri Kids Dental Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781136000000",
    "number": "1356201479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 S RANGE LINE RD STE D",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648015519",
            "telephone_number": "417-586-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 S RANGE LINE RD STE D",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648015519",
            "telephone_number": "480-866-8811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI KIDS DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-12",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A",
        "authorized_official_last_name": "ZWICKY",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "480-866-8811"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Missouri Kids Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.