Provider Demographics
NPI:1477611234
Name:SMILES ON WHEELS
Entity type:Organization
Organization Name:SMILES ON WHEELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:517-740-2596
Mailing Address - Street 1:7040 MCKAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201
Mailing Address - Country:US
Mailing Address - Phone:517-740-2596
Mailing Address - Fax:517-740-2596
Practice Address - Street 1:122 HIGHLAND DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-704-2596
Practice Address - Fax:517-740-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2024-05-22
Deactivation Date:2023-10-06
Deactivation Code:
Reactivation Date:2024-05-21
Provider Licenses
StateLicense IDTaxonomies
MI2901007028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty