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

1 Mid Rivers Mall Dr Ste 310
Saint Peters, MO 63376-4323

Phone

(636) 928-7217

Fax

(636) 397-0223

NPI assigned

Dec 15, 2022

Last updated

Dec 15, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

KELSEY SMITH, 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
• Kenneth Clark Priddy, 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)
  • Wentzville, MO
  • NPI 1447962915
  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": "1671062400000",
    "number": "1801508379",
    "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": "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"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "853 Medical Dr Ste 115",
            "address_purpose": "LOCATION",
            "city": "Wentzville",
            "state": "MO",
            "postal_code": "633853825",
            "country_code": "US",
            "telephone_number": "368-873-1006",
            "fax_number": "636-887-3102",
            "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": "KELSEY SMITH, DDS, MD, PC",
        "enumeration_date": "2022-12-15",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "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": "193400000X MULTIPLE SINGLE SPECIALTY 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": "Kenneth Clark Priddy, DDS, MD, PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Saint Peters, MO
• Providers in Saint Peters, 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 Dec 15, 2022; 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.