Provider Demographics
NPI:1114465705
Name:CITY SMILES CLAYTON, LLC
Entity Type:Organization
Organization Name:CITY SMILES CLAYTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-678-7876
Mailing Address - Street 1:141 N MERAMEC AVE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3750
Mailing Address - Country:US
Mailing Address - Phone:314-678-7876
Mailing Address - Fax:314-678-7877
Practice Address - Street 1:141 N MERAMEC AVE
Practice Address - Street 2:SUITE 217
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3750
Practice Address - Country:US
Practice Address - Phone:314-678-7876
Practice Address - Fax:314-678-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15770261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental