Missouri Center for Oral Surgery and Implants LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

MISSOURI CENTER FOR ORAL SURGERY AND IMPLANTS LLC

Doing business as

First Capitol Oral and Maxillofacial Surgery
Oral and Maxillofacial Surgery at the Crossing

Practice address

853 Medical Dr Ste 115
Wentzville, MO 63385-3825

Phone

(636) 887-3100

Fax

(636) 887-3102

NPI assigned

Dec 15, 2022

Last updated

Mar 27, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

KENNETH CLARK PRIDDY, DDS, MD, PCAs reported in NPPES

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

Authorized official

Name

Dr. Kelsey Caitlin Smith, DDS, MDNPI 1205298866

Title

Partner

Phone

(314) 956-5651

Specialties & licenses 1

Addresses

Other names 3

• First Capitol Oral and Maxillofacial Surgery Doing business as
• Oral and Maxillofacial Surgery at the Crossing Doing business as
• Kelsey Smith, DDS, MD, PC Other name

Tax ID family

First Capitol Oral and Maxillofacial Surgery2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Missouri Center for Oral Surgery and Implants LLC

  dba First Capitol Oral and Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Peters, MO
  • NPI 1801508379
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelsey Caitlin Smith, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Peters, MO
  • NPI 1205298866
  NPD Authorized official
• Kenneth Clark Priddy, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Wentzville, MO
  • NPI 1598127672
  NPD

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

{
    "created_epoch": "1671062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679875200000",
    "number": "1447962915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MID RIVERS MALL DR STE 310",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633764323",
            "telephone_number": "636-928-7217",
            "fax_number": "636-397-0223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 MEDICAL DR STE 115",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853825",
            "telephone_number": "636-887-3100",
            "fax_number": "636-887-3102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Mid Rivers Mall Dr Ste 310",
            "address_purpose": "LOCATION",
            "city": "Saint Peters",
            "state": "MO",
            "postal_code": "633764323",
            "country_code": "US",
            "telephone_number": "636-928-7217",
            "fax_number": "636-397-0223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MISSOURI CENTER FOR ORAL SURGERY AND IMPLANTS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENNETH CLARK PRIDDY, DDS, MD, PC",
        "enumeration_date": "2022-12-15",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KELSEY",
        "authorized_official_middle_name": "CAITLIN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "314-956-5651",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "First Capitol Oral and Maxillofacial Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oral and Maxillofacial Surgery at the Crossing",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kelsey Smith, DDS, MD, PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lisa Orf Mikecin, PH.D.
• Chloe Lyn Miller, PT, DPT
• Heather Lynn Miller, FNP
• Kassandra Miller, MA, CIT, LPC
• Marcus Miller, MA
• Missouri CVS Pharmacy LLC (CVS Pharmacy #17410)
• Missouri CVS Pharmacy LLC (CVS Pharmacy# 10193)
• Missouri CVS Pharmacy, L.L.C. (CVS Pharmacy #18086)
• Missouri Dental Professionals, Richard Straus, DMD, PC (MyCrossroadsDentist)
• MJT Enterprises (Lice Clinics of America St. Charles)

• Oral and Maxillofacial Surgery (Dentist) in Wentzville, MO
• Providers in Wentzville, MO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; 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.