Healthcare Provider Details

I. General information

NPI: 1295463404
Provider Name (Legal Business Name): SAMUEL A MCGUIRE, DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 OAKS XING
PLAINWELL MI
49080-1933
US

IV. Provider business mailing address

380 OAKS XING
PLAINWELL MI
49080-1933
US

V. Phone/Fax

Practice location:
  • Phone: 269-888-6686
  • Fax:
Mailing address:
  • Phone: 269-888-6686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SAMUEL AUGUSTUS MCGUIRE
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 269-888-6686