Provider Demographics
NPI:1205298866
Name:SMITH, KELSEY CAITLIN (DDS, MD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:CAITLIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MID RIVERS MALL DR STE 310
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-4323
Mailing Address - Country:US
Mailing Address - Phone:163-692-8721
Mailing Address - Fax:
Practice Address - Street 1:1 MID RIVERS MALL DR STE 310
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-4323
Practice Address - Country:US
Practice Address - Phone:636-928-7217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160184831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery