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General NPI Number Information
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NPI Number | 1114741030
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Entity Type | Organization
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Legal Business Name | BELLEVILLE SMILES
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 35 MAIN ST STE 102
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City | BELLEVILLE
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State | MI
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Zip | 48111-3287
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Country | US
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Telephone | 734-697-3011
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Fax |
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Provider Business Mailing Address
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Address Line | 3123 OVERRIDGE DR
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City | ANN ARBOR
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State | MI
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Zip | 48104-4152
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN MCLAREN
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Credential | DDS, MS
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Telephone | 734-645-6548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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