Provider Demographics
NPI:1659017341
Name:U.P. SUPERIOR SMILES
Entity Type:Organization
Organization Name:U.P. SUPERIOR SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GREGORINI
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:906-630-6197
Mailing Address - Street 1:4234 I 75 BUSINESS SPUR # 218
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3620
Mailing Address - Country:US
Mailing Address - Phone:906-630-6197
Mailing Address - Fax:
Practice Address - Street 1:3125 SMART RD
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783
Practice Address - Country:US
Practice Address - Phone:906-630-6197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty