Healthcare Provider Details

I. General information

NPI: 1134570997
Provider Name (Legal Business Name): GROWING SMILES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36602 HERITAGE DR
RICHMOND MI
48062
US

IV. Provider business mailing address

51821 GRATIOT AVE.
CHESTERFIELD MI
48051
US

V. Phone/Fax

Practice location:
  • Phone: 586-727-5500
  • Fax: 586-727-3950
Mailing address:
  • Phone: 586-727-5500
  • Fax: 586-727-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901020657
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901021820
License Number StateMI

VIII. Authorized Official

Name: MRS. JULIE M SPINEK
Title or Position: GENERAL MANAGER
Credential:
Phone: 586-727-5500