# GREAT SMILE DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194946418
- **Authorized official:** DR. RANDY J BOGAUDO (PRESIDENT)
- **Authorized official phone:** (906) 786-4033

## Contact information

- **Practice address:** 2201 LUDINGTON ST, ESCANABA, MI 49829-2322
- **Practice address phone:** (906) 786-4033
- **Practice address fax:** (906) 786-9199
- **Mailing address:** 2201 LUDINGTON ST, ESCANABA, MI 49829-2322
- **Mailing address phone:** (906) 786-4033
- **Mailing address fax:** (906) 786-9199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 15587 | MI | Yes |

## Other

- **Enumeration date:** 05/02/2007
- **Last updated:** 08/22/2020