Provider Demographics
NPI:1427255843
Name:MCGUIRE, SAMUEL AUGUSTUS (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:AUGUSTUS
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 OAKS XING
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1933
Mailing Address - Country:US
Mailing Address - Phone:269-888-6686
Mailing Address - Fax:
Practice Address - Street 1:380 OAKS XING
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1933
Practice Address - Country:US
Practice Address - Phone:269-888-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011022A1223G0001X
MI29010201211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1427255843Medicaid