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General NPI Number Information
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NPI Number | 1063982965
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Entity Type | Organization
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Legal Business Name | SMILE CLINIC MOBILE DENTISTRY PC
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 12/04/2018
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Provider Practice Location Address
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Address Line | 17007 ECORSE RD
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City | ALLEN PARK
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State | MI
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Zip | 48101-2451
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Country | US
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Telephone | 313-388-7720
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Fax | 313-388-8161
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Provider Business Mailing Address
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Address Line | 17007 ECORSE RD
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City | ALLEN PARK
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State | MI
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Zip | 48101-2451
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Country | US
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Telephone | 313-388-7720
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Fax | 313-388-8161
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CLAUDIA M BELLEW
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Credential |
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Telephone | 313-388-7720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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