MEDICARE: IMPRESSIVE SMILE FAMILY DENTISTRY, DDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1932749314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPRESSIVE SMILE FAMILY DENTISTRY, DDS, PLLC

Provider Business Mailing Address
First Line	:	25711 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2046
Country	:	US
Telephone Number	:	313-565-1862
Fax Number	:	313-562-5428

Provider Business Practice Location Address
First Line	:	25711 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2046
Country	:	US
Telephone Number	:	313-565-1862
Fax Number	:	313-562-5428

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. REEM AL-ABBOUSI
Credential	:	DDS
Telephone Number	:	313-565-1862

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/13/2020

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