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General NPI Number Information
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NPI Number | 1134127152
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Entity Type | Individual
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Provider Name | DENNIS A SMALLWOOD D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 1184 CLEAVER RD
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City | CARO
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State | MI
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Zip | 48723-1143
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Country | US
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Telephone | 888-758-5709
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Fax | 888-490-5454
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Provider Business Mailing Address
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Address Line | 192 S LAKE ST
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City | PORT SANILAC
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State | MI
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Zip | 48469-9620
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | DS005982
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License Number State | MI
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