Provider Demographics
NPI:1235950890
Name:GALLERY B SMILES
Entity type:Organization
Organization Name:GALLERY B SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:906-428-1616
Mailing Address - Street 1:1709 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-2019
Mailing Address - Country:US
Mailing Address - Phone:906-428-1616
Mailing Address - Fax:
Practice Address - Street 1:1103 DELTA AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MI
Practice Address - Zip Code:49837-1438
Practice Address - Country:US
Practice Address - Phone:906-428-1616
Practice Address - Fax:906-428-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty