Provider Demographics
NPI:1518152883
Name:GROWING SMILES, LLC
Entity Type:Organization
Organization Name:GROWING SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-856-5600
Mailing Address - Street 1:1425 WAKARUSA DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3832
Mailing Address - Country:US
Mailing Address - Phone:785-856-5600
Mailing Address - Fax:785-856-5601
Practice Address - Street 1:1425 WAKARUSA DR
Practice Address - Street 2:SUITE D
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3832
Practice Address - Country:US
Practice Address - Phone:785-856-5600
Practice Address - Fax:785-856-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60453261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental