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General NPI Number Information
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NPI Number | 1417557521
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Entity Type | Organization
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Legal Business Name | ST JOHNS SMILES
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 1014 N CLINTON AVE
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City | SAINT JOHNS
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State | MI
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Zip | 48879-1092
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Country | US
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Telephone | 989-224-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 N CLINTON AVE
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City | SAINT JOHNS
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State | MI
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Zip | 48879-1092
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Country | US
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Telephone | 989-224-6727
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DARLENE BYRNES
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Credential |
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Telephone | 989-224-6727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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