Healthcare Provider Details

I. General information

NPI: 1477134112
Provider Name (Legal Business Name): SMILE ZONE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 BROOKSHIRE DR
MONROE MI
48161
US

IV. Provider business mailing address

5290 W BROOKSHIRE ST STE 2
MONROE MI
48161-3794
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-3311
  • Fax: 734-242-6482
Mailing address:
  • Phone: 734-242-3311
  • Fax: 734-242-6482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SCHAAF
Title or Position: DIRECTOR
Credential:
Phone: 269-217-6442