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General NPI Number Information
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NPI Number | 1831837046
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Entity Type | Organization
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Legal Business Name | NESMITH PERIODONTICS & DENTAL IMPLANTS PLLC
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 2115 M 119
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City | PETOSKEY
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State | MI
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Zip | 49770-9042
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Country | US
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Telephone | 989-657-4858
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Fax |
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Provider Business Mailing Address
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Address Line | 546 W LAKE ST
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City | PETOSKEY
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State | MI
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Zip | 49770-2225
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Country | US
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Telephone | 989-657-4858
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ELIZABETH NESMITH
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Credential | DMD
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Telephone | 989-657-4858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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