| Dba: Little Grinz | |
|
565 Howdershell Rd Florissant MO 63031 | |
| (314) 731-6150 | |
| (314) 731-6149 |
| Full Name | Dba: Little Grinz |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 565 Howdershell Rd, Florissant, Missouri |
| Authorized Official Name and Position | Kari Ann Hicks (OFFICE MANAGER) |
| Authorized Official Contact | 4175011048 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dba: Little Grinz 1701 W. Sunshine Suite Q Springfield MO 65807-2261 Ph: (417) 501-1048 | Dba: Little Grinz 565 Howdershell Rd Florissant MO 63031 Ph: (314) 731-6150 |
| NPI Number | 1114279460 |
|---|---|
| Provider Enumeration Date | 10/11/2012 |
| Last Update Date | 06/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114279460 | NPI | - | NPPES |
| 1215241005 | Medicaid | MO | |
| 1891704193 | Medicaid | MO | |
| 1285984013. | Other | MO | MERAMAC FAMILY DENTISTRY ANOTHER LOCATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2006012741 (Missouri) | Primary |
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