Provider Demographics
NPI:1730519661
Name:GROWING SMILES PEDIATRIC DENTISTRY P.C.
Entity type:Organization
Organization Name:GROWING SMILES PEDIATRIC DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGGAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-734-0009
Mailing Address - Street 1:1750 GRAND RIDGE CT NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7043
Mailing Address - Country:US
Mailing Address - Phone:616-988-9485
Mailing Address - Fax:616-988-9486
Practice Address - Street 1:1750 GRAND RIDGE CT NE
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7043
Practice Address - Country:US
Practice Address - Phone:616-988-9485
Practice Address - Fax:616-988-9486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010204731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty