Provider Demographics
NPI:1669262150
Name:BRANSON KIDS DENTAL LLC
Entity type:Organization
Organization Name:BRANSON KIDS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUDKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-243-0020
Mailing Address - Street 1:1531 E SUNSHINE ST STE E10
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1237
Mailing Address - Country:US
Mailing Address - Phone:417-883-5866
Mailing Address - Fax:
Practice Address - Street 1:714 HWY 248 STE 515
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3804
Practice Address - Country:US
Practice Address - Phone:417-883-5866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental