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General NPI Number Information
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NPI Number | 1316570526
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Entity Type | Organization
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Legal Business Name | FENTON SMILES PLLC
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Dates
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Enumeration Date | 02/16/2020
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Last Update Date | 02/16/2020
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Provider Practice Location Address
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Address Line | 3309 W SILVER LAKE RD
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City | FENTON
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State | MI
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Zip | 48430-1333
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Country | US
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Telephone | 810-354-5313
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Fax |
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Provider Business Mailing Address
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Address Line | 10357 MAPLE RD
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City | BIRCH RUN
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State | MI
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Zip | 48415-8469
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Country | US
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Telephone | 989-415-6896
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALEX LEE GIVENS
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Credential | DDS
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Telephone | 989-415-6896
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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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