NPIMap

Organization Active NPI

Smile Up Dental LLC

  • General Practice Dentistry
  • Nixa, MO
National Provider Identifier
1356817340
Registry record updated Oct 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SMILE UP DENTAL LLC
Practice address
708 W Mount Vernon St
Nixa, MO 65714-9682
Phone
(417) 494-5017
NPI assigned
Oct 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2018

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

Authorized official

Name
Dr. Anthony LeeNPI 1831207711
Title
Owner/Dentist
Phone
(417) 494-5017

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

708 W Mount Vernon St
Nixa, MO 65714-9682

Mailing address

708 W Mount Vernon St
Nixa, MO 65714-9682
Phone (417) 494-5017

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539734400000",
    "number": "1356817340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 W MOUNT VERNON ST",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657149682",
            "telephone_number": "417-494-5017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 W MOUNT VERNON ST",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657149682",
            "telephone_number": "417-494-5017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE UP DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-17",
        "last_updated": "2018-10-17",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "417-494-5017",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nixa, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; 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.