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General NPI Number Information
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NPI Number | 1922677335
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Entity Type | Organization
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Legal Business Name | SMILE ITHACA PLLC
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 108 S MAIN ST
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City | ITHACA
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State | MI
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Zip | 48847-1440
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Country | US
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Telephone | 989-875-4832
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Fax |
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Provider Business Mailing Address
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Address Line | 128 COLUMBUS AVE
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City | GRAND HAVEN
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State | MI
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Zip | 49417-1224
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Country | US
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Telephone | 616-268-2090
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | DARREN RIOPELLE
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Credential | DDS
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Telephone | 616-502-8023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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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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