Organization
MI SMILES DENTAL GRAND RAPIDS SE PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA ROGERS (DIRECTOR OF FINANCE)
(616) 379-4013
Entity
Organization
Contact information
Practice address
2100 RAYBROOK ST SE STE 106, GRAND RAPIDS, MI 49546-5783
(616) 942-2870
Mailing address
3250 CENTRAL BLVD, HUDSONVILLE, MI 49426-1439
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/16/2021
Last updated
09/16/2021
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