Provider Demographics
NPI:1275830416
Name:HEALTHY SMILES DENTAL CARE OF LANSING
Entity Type:Organization
Organization Name:HEALTHY SMILES DENTAL CARE OF LANSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-751-5106
Mailing Address - Street 1:2829 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4331
Mailing Address - Country:US
Mailing Address - Phone:517-333-3160
Mailing Address - Fax:517-333-3166
Practice Address - Street 1:2829 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4331
Practice Address - Country:US
Practice Address - Phone:517-333-3160
Practice Address - Fax:517-333-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0157031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty