Provider Demographics
NPI:1417373036
Name:SMILE CENTER PLLC
Entity Type:Organization
Organization Name:SMILE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KUIPERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-646-6540
Mailing Address - Street 1:3500 PARK STREET
Mailing Address - Street 2:SMILE CENTER PLLC
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444
Mailing Address - Country:US
Mailing Address - Phone:231-733-4409
Mailing Address - Fax:231-733-2256
Practice Address - Street 1:3500 PARK STREET
Practice Address - Street 2:SMILE CENTER PLLC
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444
Practice Address - Country:US
Practice Address - Phone:231-733-4409
Practice Address - Fax:231-733-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty