Provider Demographics
NPI:1821103557
Name:KIDS GRINS..STRAIGHT SMILES
Entity Type:Organization
Organization Name:KIDS GRINS..STRAIGHT SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST-OWNER OF ORGANIZATION
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RAFAILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-247-5544
Mailing Address - Street 1:49050 SCHOENHERR ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3848
Mailing Address - Country:US
Mailing Address - Phone:586-247-5544
Mailing Address - Fax:586-247-6677
Practice Address - Street 1:49050 SCHOENHERR ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3848
Practice Address - Country:US
Practice Address - Phone:586-247-5544
Practice Address - Fax:586-247-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010104661223P0221X
MI29010162611223X0400X
MI1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty