Michael A Smith, DDS, MS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

2901015630 Issued in MI

Practice address

12662 Riley St
Suite #130
Holland, MI 49424-8023

Phone

(616) 399-6811

Fax

(616) 399-6812

NPI assigned

Aug 10, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366070400000",
    "number": "1174524243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12662 RILEY ST",
            "address_2": "SUITE #130",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494248023",
            "telephone_number": "616-399-6811",
            "fax_number": "616-399-6812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12662 RILEY ST",
            "address_2": "SUITE #130",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494248023",
            "telephone_number": "616-399-6811",
            "fax_number": "616-399-6812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2013-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MI",
            "license": "2901015630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeannette Smith
• Julie Anne Smith, RN
• Kathleen D. Smith, PSYCHOLOGIST LLP
• Mallory Ann Smith, PA-C
• Maureen Smith
• Michael Joseph Smith
• Nancy Jo Smith, MA
• Natasha Smith
• Nedgra Smith, LPC LLMSW
• Pamela Smith, NP-C

• Endodontics in Holland, MI
• Providers in Holland, MI by specialty
• Endodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.