Provider Demographics
NPI:1740649573
Name:SMILE ORTHODONTICS BILLING LLC
Entity type:Organization
Organization Name:SMILE ORTHODONTICS BILLING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOPELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-850-3970
Mailing Address - Street 1:1203 S BEECHTREE ST
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1203 S BEECHTREE ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2839
Practice Address - Country:US
Practice Address - Phone:616-850-3970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMILE GRAND HAVEN PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010214421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty