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General NPI Number Information
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NPI Number | 1457616500
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Entity Type | Organization
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Legal Business Name | TENDER TOUCH DENTAL SERVICES
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 19173 SANTA BARBARA DR
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City | DETROIT
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State | MI
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Zip | 48221-1624
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Country | US
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Telephone | 313-505-6665
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Fax |
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Provider Business Mailing Address
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Address Line | 19173 SANTA BARBARA DR
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City | DETROIT
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State | MI
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Zip | 48221-1624
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Country | US
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Telephone | 313-505-6665
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. JACLYN SMITH
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Credential | RDH
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Telephone | 313-505-6665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902016147
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License Number State | MI
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