Healthcare Provider Details

I. General information

NPI: 1689590226
Provider Name (Legal Business Name): 97 SMILES OF ALLEN PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17234 GODDARD RD
ALLEN PARK MI
48101-4100
US

IV. Provider business mailing address

17234 GODDARD RD
ALLEN PARK MI
48101-4100
US

V. Phone/Fax

Practice location:
  • Phone: 313-279-9797
  • Fax:
Mailing address:
  • Phone: 313-279-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN DUNFORD
Title or Position: BILLING & CREDENTIALING MANAGER
Credential:
Phone: 734-788-8712