Missouri Smiles LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MISSOURI SMILES LLC

Practice address

3621 Discovery Parkway
Ste 101
Columbia, MO 65201

Phone

(573) 424-2067

NPI assigned

Aug 10, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Kyle Lisenby, DMDNPI 1629248414

Title

Dentist Owner

Phone

(573) 424-2067

Specialties & licenses 1

Addresses

Other names 1

• TBD Doing business as

Locations

Practitioners 1

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

• Kyle Lisenby, D.M.D.

  • Dentist
  • Columbia, MO
  • NPI 1629248414
  NPD Authorized official

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

{
    "created_epoch": "1691625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1508549130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2102 PORT TOWNSEND CT",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652031014",
            "telephone_number": "573-424-2067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3621 DISCOVERY PARKWAY",
            "address_2": "STE 101",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "65201",
            "telephone_number": "573-424-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI SMILES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-10",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-08",
        "status": "A",
        "authorized_official_last_name": "LISENBY",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "573-424-2067",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TBD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Missouri Dental Professionals, Richard Straus, DMD, PC
• Missouri Ear Nose and Throat Center
• Missouri Ear Nose and Throat Center
• Missouri Obesity Center,LLC
• Missouri Retina Consultants PC
• Lauren Ann Mistler, NP-C
• Dolly A. Mitchell, LMSW
• Dora Denise Mitchell, LPC
• Douglas Roy Mitchell, M.D.
• Laura Grace Mitchell, ANP

• Dental Clinic/Center in Columbia, MO
• Providers in Columbia, MO by specialty
• Dental Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.