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General NPI Number Information
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NPI Number | 1821471616
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILE PLC
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 2021 44TH ST SW
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City | GRAND RAPIDS
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State | MI
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Zip | 49508
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Country | US
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Telephone | 616-281-8338
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Fax | 616-281-1162
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Provider Business Mailing Address
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Address Line | PO BOX 8228
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City | KENTWOOD
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State | MI
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Zip | 49518-8228
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Country | US
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Telephone | 616-281-8338
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Fax | 616-281-1162
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | SUZZETTE ONA
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Credential | DMD
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Telephone | 616-281-8338
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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 | 17705
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License Number State | MI
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