Provider Demographics
NPI:1528030962
Name:SMILEY, COLETTE R (DDS)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:R
Last Name:SMILEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3299 CLEAR VISTA CT NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9477
Mailing Address - Country:US
Mailing Address - Phone:616-361-0654
Mailing Address - Fax:616-361-9823
Practice Address - Street 1:3299 CLEAR VISTA CT NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9477
Practice Address - Country:US
Practice Address - Phone:616-361-0654
Practice Address - Fax:616-361-9823
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0146381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice