NPIMap

Organization Active NPI

Smilie's Pediatric Dentistry

  • Pediatric Dentistry
  • Grand Rapids, MI
National Provider Identifier
1356085930
Registry record updated Apr 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SMILIE'S PEDIATRIC DENTISTRY
Practice address
2017 Eastcastle Drive SE
Suite a
Grand Rapids, MI 49508-8872
Phone
(616) 455-4646
Fax
(616) 455-6024
NPI assigned
Apr 21, 2022
Last updated
Apr 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2022

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

Authorized official

Name
Douglas Eugene Ladue III, DDSNPI 1376771618
Title
Owner/Dentist
Phone
(616) 455-4646

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

2017 Eastcastle Drive SE
Suite a
Grand Rapids, MI 49508-8872

Mailing address

2017 Eastcastle Drive SE
Suite a
Grand Rapids, MI 49508-8872
Phone (616) 455-4646

National Provider Directory

National Provider Directory
Tax ID family
Smilie's Pediatric Denitstry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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": "1650499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650499200000",
    "number": "1356085930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2017 EASTCASTLE DRIVE SE",
            "address_2": "SUITE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495088872",
            "telephone_number": "616-455-4646",
            "fax_number": "616-455-6024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2017 EASTCASTLE DRIVE SE",
            "address_2": "SUITE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495088872",
            "telephone_number": "616-455-4646",
            "fax_number": "616-455-6024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILIE'S PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-21",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A",
        "authorized_official_last_name": "LADUE",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "616-455-4646",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2022; 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.