Provider Demographics
NPI:1831837046
Name:NESMITH PERIODONTICS & DENTAL IMPLANTS PLLC
Entity type:Organization
Organization Name:NESMITH PERIODONTICS & DENTAL IMPLANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NESMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:989-657-4858
Mailing Address - Street 1:546 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2225
Mailing Address - Country:US
Mailing Address - Phone:989-657-4858
Mailing Address - Fax:
Practice Address - Street 1:2115 M 119
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9042
Practice Address - Country:US
Practice Address - Phone:989-657-4858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty