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General NPI Number Information
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NPI Number | 1659123040
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Entity Type | Organization
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Legal Business Name | STATE STREET SMILES PLLC
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 300 S STATE ST STE 2
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City | ZEELAND
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State | MI
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Zip | 49464-1677
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Country | US
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Telephone | 616-322-5491
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Fax |
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Provider Business Mailing Address
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Address Line | 300 S STATE ST STE 2
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City | ZEELAND
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State | MI
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Zip | 49464-1677
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Country | US
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Telephone | 616-322-5491
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT/CEO
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Name | DR. AUSTIN ROBERT STEBBINS
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Credential | DDS
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Telephone | 616-322-5491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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