Healthcare Provider Details

I. General information

NPI: 1568684959
Provider Name (Legal Business Name): WEST MICHIGAN ENDODONTISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 BURTON STREET, SE
GRAND RAPIDS MI
49546-5343
US

IV. Provider business mailing address

3366 BURTON STREET, SE
GRAND RAPIDS MI
49546-5343
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-3541
  • Fax:
Mailing address:
  • Phone: 616-949-3541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ARIC C. SMITH
Title or Position: PARTNER
Credential: D.D.S., M.S.
Phone: 616-949-3541