Healthcare Provider Details

I. General information

NPI: 1457616500
Provider Name (Legal Business Name): TENDER TOUCH DENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19173 SANTA BARBARA DR
DETROIT MI
48221-1624
US

IV. Provider business mailing address

19173 SANTA BARBARA DR
DETROIT MI
48221-1624
US

V. Phone/Fax

Practice location:
  • Phone: 313-505-6665
  • Fax:
Mailing address:
  • Phone: 313-505-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902016147
License Number StateMI

VIII. Authorized Official

Name: MS. JACLYN SMITH
Title or Position: PROGRAM DIRECTOR
Credential: RDH
Phone: 313-505-6665