Provider Demographics
NPI:1497366421
Name:JOSHUA SMITH DENTAL PLLC
Entity Type:Organization
Organization Name:JOSHUA SMITH DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-531-7480
Mailing Address - Street 1:3050 IVANREST AVE SW STE A
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2895
Mailing Address - Country:US
Mailing Address - Phone:616-531-7480
Mailing Address - Fax:616-531-4552
Practice Address - Street 1:3050 IVANREST AVE SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1400
Practice Address - Country:US
Practice Address - Phone:616-531-7480
Practice Address - Fax:616-531-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental