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General NPI Number Information
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NPI Number | 1154998201
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Entity Type | Individual
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Provider Name | RUBY MARINA SMITH DMD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 933 3 MILE RD NW STE 110
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City | GRAND RAPIDS
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State | MI
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Zip | 49544-1673
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Country | US
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Telephone | 616-784-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 707 PRUDDEN ST UNIT 222
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City | LANSING
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State | MI
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Zip | 48906-5388
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Country | US
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Telephone | 517-614-3959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901600907
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License Number State | MI
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