Healthcare Provider Details

I. General information

NPI: 1386550903
Provider Name (Legal Business Name): SIGNATURE DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8657 GREENFIELD RD STE A
DETROIT MI
48228-2224
US

IV. Provider business mailing address

8657 GREENFIELD RD STE A
DETROIT MI
48228-2224
US

V. Phone/Fax

Practice location:
  • Phone: 313-644-4401
  • Fax:
Mailing address:
  • Phone: 313-644-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MANAL FAYEK ISMAIL
Title or Position: PROVIDER
Credential: DDM
Phone: 313-644-4401