Healthcare Provider Details

I. General information

NPI: 1437042611
Provider Name (Legal Business Name): BIG SMILE MOBILE HYGIENE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 E DAVISON ST
DETROIT MI
48212-3510
US

IV. Provider business mailing address

3130 HANLEY ST
HAMTRAMCK MI
48212-3510
US

V. Phone/Fax

Practice location:
  • Phone: 313-444-0028
  • Fax:
Mailing address:
  • Phone: 313-444-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. TAISIR SAIF-SALEH ALI
Title or Position: REGISTERED DENTAL HYGIENIST
Credential: RDH, BSDH
Phone: 313-444-0028