Healthcare Provider Details

I. General information

NPI: 1346953072
Provider Name (Legal Business Name): MOXY DENTAL AND AIRWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 1/2 E MAIN AVE
ZEELAND MI
49464-1735
US

IV. Provider business mailing address

133 1/2 E MAIN AVE
ZEELAND MI
49464-1735
US

V. Phone/Fax

Practice location:
  • Phone: 616-772-7010
  • Fax: 616-772-7225
Mailing address:
  • Phone: 616-772-7010
  • Fax: 616-772-7225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MEREDITH SMEDLEY
Title or Position: OWNER
Credential: DDS
Phone: 616-772-7010