Serenity Smiles Family Dentistry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2012015356 Issued in MO

Legal business name

SERENITY SMILES FAMILY DENTISTRY, LLC

Practice address

2401 Bernadette Dr
Ste 217
Columbia, MO 65203-4672

Phone

(573) 445-1100

NPI assigned

Jun 5, 2013

Organization subpart

No

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

Authorized official

Name

Dana Derdeuff, D.D.S.

Title

Owner/Dentist

Phone

(573) 356-4029

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1370390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370390400000",
    "number": "1891133583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 SKYLANE DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652021709",
            "telephone_number": "573-445-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 BERNADETTE DR",
            "address_2": "STE 217",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652034672",
            "telephone_number": "573-445-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY SMILES FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-05",
        "last_updated": "2013-06-05",
        "status": "A",
        "authorized_official_last_name": "DERDEUFF",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "573-356-4029",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2012015356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Regina M Selva, M.D.
• Thomas J Selva, MD
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• Syndee J Serr, ANP
• Seth Showalter LCSW LLC
• Anjna Sethi, MD
• Anmol Sethi, DDS
• Yash Pal Sethi, MD

• General Practice Dentistry in Columbia, MO
• Providers in Columbia, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; 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.