MEDICARE: RADIANT SMILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1770286270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT SMILES

Provider Business Mailing Address
First Line	:	2634 SPRINGMILL AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-6991
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 PLAINFIELD AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-1229
Country	:	US
Telephone Number	:	616-389-0505
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MALAVI PATEL
Credential	:	DMD
Telephone Number	:	616-389-0505

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	03/23/2023

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Directions to “RADIANT SMILES ” Practice Location

Language	Start Address	Practice Location

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