Organization
PURA VIDA SMILES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BERTOLLINI (PRM)
(866) 273-8204
Entity
Organization
Contact information
Practice address
1113 BOARDMAN RD, JACKSON, MI 49202-1901
(517) 768-8100
(517) 780-0806
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(866) 273-8204
(866) 803-4943
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15663
MI
Other
Enumeration date
01/09/2014
Last updated
01/09/2014
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