Organization Active NPI

97 Smiles of Jackson

  • Dentist
  • Jackson, MI
National Provider Identifier
1104743624
Registry record updated Jul 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
97 SMILES OF JACKSON
Practice address
826 N Wisner St
Jackson, MI 49202-3141
Phone
(517) 787-0401
NPI assigned
Jul 6, 2026
Last updated
Jul 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan Dunford
Title
Billing & Credentialing Manager
Phone
(734) 788-8712

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

826 N Wisner St
Jackson, MI 49202-3141

Mailing address

826 N Wisner St
Jackson, MI 49202-3141
Phone (517) 787-0401

National Provider Directory

National Provider Directory

Locations

826 N Wisner St
Jackson, MI 49202
Phone (517) 787-0401

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1783296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783296000000",
    "number": "1104743624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 N WISNER ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492023141",
            "telephone_number": "517-787-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 N WISNER ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492023141",
            "telephone_number": "517-787-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "97 SMILES OF JACKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-06",
        "last_updated": "2026-07-06",
        "certification_date": "2026-07-05",
        "status": "A",
        "authorized_official_last_name": "DUNFORD",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "BILLING & CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "734-788-8712"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.