Provider Demographics
NPI:1023774460
Name:HILLSDALE SMILES
Entity type:Organization
Organization Name:HILLSDALE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-439-9394
Mailing Address - Street 1:1 BUDLONG ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1844
Mailing Address - Country:US
Mailing Address - Phone:517-439-9396
Mailing Address - Fax:517-439-9396
Practice Address - Street 1:1 BUDLONG ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1844
Practice Address - Country:US
Practice Address - Phone:517-439-9396
Practice Address - Fax:517-439-9396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710008065Medicaid