Provider Demographics
NPI:1932647591
Name:POLISHED - MELISSA A SMITH DDS PC
Entity Type:Organization
Organization Name:POLISHED - MELISSA A SMITH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-667-9192
Mailing Address - Street 1:14560 MANCHESTER RD
Mailing Address - Street 2:STE 27
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3933
Mailing Address - Country:US
Mailing Address - Phone:636-394-4275
Mailing Address - Fax:636-394-1188
Practice Address - Street 1:14560 MANCHESTER RD
Practice Address - Street 2:STE 27
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3933
Practice Address - Country:US
Practice Address - Phone:636-394-4275
Practice Address - Fax:636-394-1188
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
MO20040132541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty