Organization
GREAT SMILE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDY J BOGAUDO (PRESIDENT)
(906) 786-4033
Entity
Organization
Contact information
Practice address
2201 LUDINGTON ST, ESCANABA, MI 49829-2322
(906) 786-4033
(906) 786-9199
Mailing address
2201 LUDINGTON ST, ESCANABA, MI 49829-2322
(906) 786-4033
(906) 786-9199
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15587
MI
Other
Enumeration date
05/02/2007
Last updated
08/22/2020
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