Provider Demographics
NPI:1134570997
Name:GROWING SMILES, PLLC
Entity type:Organization
Organization Name:GROWING SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPINEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-727-5500
Mailing Address - Street 1:51821 GRATIOT AVE.
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051
Mailing Address - Country:US
Mailing Address - Phone:586-727-5500
Mailing Address - Fax:586-727-3950
Practice Address - Street 1:36602 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062
Practice Address - Country:US
Practice Address - Phone:586-727-5500
Practice Address - Fax:586-727-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010218201223P0300X
MI29010206571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1083857783OtherPEDIATRIC DENTIST
MI1588911788OtherPEDIATRIC DENTIST