Provider Demographics
NPI:1952715971
Name:LITTLE URBAN SMILES
Entity Type:Organization
Organization Name:LITTLE URBAN SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TALISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:314-367-1434
Mailing Address - Street 1:1301 N KINGSHIGHWAY BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-1408
Mailing Address - Country:US
Mailing Address - Phone:314-367-1434
Mailing Address - Fax:
Practice Address - Street 1:1301 N KINGSHIGHWAY BLVD
Practice Address - Street 2:STE 2
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-1408
Practice Address - Country:US
Practice Address - Phone:314-367-1434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003732124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty