Provider Demographics
NPI:1265667398
Name:SHARP SMILE CENTER
Entity Type:Organization
Organization Name:SHARP SMILE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-344-4004
Mailing Address - Street 1:2914 S BURDICK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-6524
Mailing Address - Country:US
Mailing Address - Phone:269-344-4004
Mailing Address - Fax:269-382-5006
Practice Address - Street 1:2914 S BURDICK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-6524
Practice Address - Country:US
Practice Address - Phone:269-344-4004
Practice Address - Fax:269-382-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI128451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty