West Edgewood Dental Small Smiles, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12095 Issued in MO

Legal business name

WEST EDGEWOOD DENTAL SMALL SMILES, LLC

Practice address

3306 Emerald LN
Jefferson City, MO 65109-6877

Phone

(573) 638-3897

Fax

(573) 761-0515

NPI assigned

Apr 11, 2007

Organization subpart

No

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

Authorized official

Name

Randy Burrow

Title

Operations Manager

Phone

(573) 638-3897

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982827465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3306 EMERALD LN",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096877",
            "telephone_number": "573-638-3897",
            "fax_number": "573-761-0515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3306 EMERALD LN",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096877",
            "telephone_number": "573-638-3897",
            "fax_number": "573-761-0515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST EDGEWOOD DENTAL SMALL SMILES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BURROW",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "573-638-3897"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "12095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vernon Dale Welschmeyer, MSN, APRN, FNP-BC
• Jeannette Lucille Welty, LCSW
• Hilary Marie Wendell, D.C.
• Kimberly Werdehausen
• Nathan David Wesche, PHARM.D
• Debra West
• Douglas Alan West, MD
• Wheat Chiropractic & Wellness Center, LLC
• Wheat Chiropractic and Wellness Center, LLC
• Emily Caroline Wheat, MD

• General Practice Dentistry in Jefferson City, MO
• Providers in Jefferson City, 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 Aug 22, 2020; 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.