Healthcare Provider Details

I. General information

NPI: 1164299525
Provider Name (Legal Business Name): NEW SMILES NEW BEGINNINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 1/2 ORANGE ST
JACKSON MI
49202-3654
US

IV. Provider business mailing address

320 1/2 ORANGE ST
JACKSON MI
49202-3654
US

V. Phone/Fax

Practice location:
  • Phone: 517-513-4923
  • Fax:
Mailing address:
  • Phone: 517-513-4923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAZMYN RAGLAND
Title or Position: EXECUTIVE DIRECTOR
Credential: BSDH, RDH, RDA
Phone: 517-513-4923