Healthcare Provider Details

I. General information

NPI: 1508512294
Provider Name (Legal Business Name): SMA ENDODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 KIRTS BLVD STE 100
TROY MI
48084-4853
US

IV. Provider business mailing address

2294 CHESTNUT DR
BLOOMFIELD HILLS MI
48304-2106
US

V. Phone/Fax

Practice location:
  • Phone: 616-322-8690
  • Fax:
Mailing address:
  • Phone: 616-322-8690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SARMAD M ALYAS
Title or Position: ENDODONTIST
Credential: DDS, MSD
Phone: 616-322-8690