Healthcare Provider Details

I. General information

NPI: 1134127152
Provider Name (Legal Business Name): DENNIS A SMALLWOOD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1184 CLEAVER RD
CARO MI
48723-1143
US

IV. Provider business mailing address

192 S LAKE ST
PORT SANILAC MI
48469-9620
US

V. Phone/Fax

Practice location:
  • Phone: 888-758-5709
  • Fax: 888-490-5454
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberDS005982
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: