Provider Demographics
NPI:1841231644
Name:FAMILY SMILECARE CENTER
Entity Type:Organization
Organization Name:FAMILY SMILECARE CENTER
Other - Org Name:RENEE MAIKON, DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MAIKON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-362-8657
Mailing Address - Street 1:1630 32ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402
Mailing Address - Country:US
Mailing Address - Phone:319-362-8657
Mailing Address - Fax:319-362-1824
Practice Address - Street 1:1630 32ND ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-362-8657
Practice Address - Fax:319-362-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA73081223G0001X
IA48701223G0001X
IA073081223G0001X
IA080651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0247759Medicaid
IA55943OtherBLUE CROSS