Healthcare Provider Details

I. General information

NPI: 1386955136
Provider Name (Legal Business Name): SWEET SMILES DENTAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2010
Last Update Date: 08/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19950 MANOR ST
DETROIT MI
48221-1040
US

IV. Provider business mailing address

19950 MANOR ST
DETROIT MI
48221-1040
US

V. Phone/Fax

Practice location:
  • Phone: 313-744-0145
  • Fax:
Mailing address:
  • Phone: 313-744-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902013061
License Number StateMI

VIII. Authorized Official

Name: ROBYN J. BROWNE
Title or Position: PRESIDENT
Credential: RDH
Phone: 313-744-0145