Healthcare Provider Details

I. General information

NPI: 1174524243
Provider Name (Legal Business Name): MICHAEL A SMITH DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12662 RILEY ST SUITE #130
HOLLAND MI
49424-8023
US

IV. Provider business mailing address

12662 RILEY ST SUITE #130
HOLLAND MI
49424-8023
US

V. Phone/Fax

Practice location:
  • Phone: 616-399-6811
  • Fax: 616-399-6812
Mailing address:
  • Phone: 616-399-6811
  • Fax: 616-399-6812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901015630
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: