Healthcare Provider Details

I. General information

NPI: 1811690480
Provider Name (Legal Business Name): KAMIL'S SMILE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24611 COOLIDGE HWY
OAK PARK MI
48237-1449
US

IV. Provider business mailing address

24611 COOLIDGE HWY
OAK PARK MI
48237-1449
US

V. Phone/Fax

Practice location:
  • Phone: 248-291-5443
  • Fax:
Mailing address:
  • Phone: 248-291-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: NABIH KIZY
Title or Position: MANAGER
Credential: MANAGER
Phone: 586-709-4210