Provider Demographics
NPI:1366234031
Name:KEEP MI SMILE CASSOPOLIS PC
Entity type:Organization
Organization Name:KEEP MI SMILE CASSOPOLIS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:PLIKERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-216-9298
Mailing Address - Street 1:17 VINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-2375
Mailing Address - Country:US
Mailing Address - Phone:269-651-6700
Mailing Address - Fax:269-659-8604
Practice Address - Street 1:62225 M 62
Practice Address - Street 2:
Practice Address - City:CASSOPOLIS
Practice Address - State:MI
Practice Address - Zip Code:49031-8733
Practice Address - Country:US
Practice Address - Phone:269-445-8636
Practice Address - Fax:269-659-8604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental