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General NPI Number Information
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NPI Number | 1891654612
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Entity Type | Organization
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Legal Business Name | 97 SMILES OF GRAND RAPIDS
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Dates
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Enumeration Date | 01/19/2026
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 2300 3 MILE RD NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3956
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Country | US
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Telephone | 616-365-8699
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 3 MILE RD NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3956
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Country | US
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Telephone | 616-365-8699
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Fax |
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Authorized Official
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Title or Position | BILLING & CREDENTIALING MANAGER
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Name | SUSAN DUNFORD
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Credential |
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Telephone | 313-342-1997
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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 |
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License Number State |
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