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General NPI Number Information
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NPI Number | 1063920932
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Entity Type | Organization
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Legal Business Name | NICE SMILE DENTISTRY PC
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Dates
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Enumeration Date | 01/13/2018
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Last Update Date | 01/13/2018
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Provider Practice Location Address
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Address Line | 1052 E WEST MAPLE RD
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City | WALLED LAKE
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State | MI
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Zip | 48390-3571
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Country | US
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Telephone | 248-624-5533
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Fax |
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Provider Business Mailing Address
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Address Line | 1052 E WEST MAPLE RD
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City | WALLED LAKE
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State | MI
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Zip | 48390-3571
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Country | US
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Telephone | 313-269-4564
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE GEORGES CHABIAAA
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Credential | DDS
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Telephone | 248-624-5533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901017752
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License Number State | MI
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