Healthcare Provider Details

I. General information

NPI: 1023774460
Provider Name (Legal Business Name): HILLSDALE SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BUDLONG ST
HILLSDALE MI
49242-1844
US

IV. Provider business mailing address

1 BUDLONG ST
HILLSDALE MI
49242-1844
US

V. Phone/Fax

Practice location:
  • Phone: 517-439-9396
  • Fax: 517-439-9396
Mailing address:
  • Phone: 517-439-9396
  • Fax: 517-439-9396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN FRAWLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 517-439-9394