Provider Demographics
NPI:1356085930
Name:SMILIE'S PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:SMILIE'S PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:LADUE
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-455-4646
Mailing Address - Street 1:2017 EASTCASTLE DRIVE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-8872
Mailing Address - Country:US
Mailing Address - Phone:616-455-4646
Mailing Address - Fax:616-455-6024
Practice Address - Street 1:2017 EASTCASTLE DRIVE SE
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-8872
Practice Address - Country:US
Practice Address - Phone:616-455-4646
Practice Address - Fax:616-455-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty