Provider Demographics
NPI:1801017173
Name:HEALTHY SMILE CENTER PC
Entity Type:Organization
Organization Name:HEALTHY SMILE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA-CRIST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-969-4840
Mailing Address - Street 1:9 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-4673
Mailing Address - Country:US
Mailing Address - Phone:248-969-4840
Mailing Address - Fax:248-969-4841
Practice Address - Street 1:9 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-4673
Practice Address - Country:US
Practice Address - Phone:248-969-4840
Practice Address - Fax:248-969-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010168891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty