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General NPI Number Information
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NPI Number | 1477134112
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Entity Type | Organization
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Legal Business Name | SMILE ZONE PLLC
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 5290 BROOKSHIRE DR
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City | MONROE
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State | MI
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Zip | 48161
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Country | US
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Telephone | 734-242-3311
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Fax | 734-242-6482
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Provider Business Mailing Address
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Address Line | 5290 W BROOKSHIRE ST STE 2
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City | MONROE
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State | MI
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Zip | 48161-3794
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Country | US
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Telephone | 734-242-3311
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Fax | 734-242-6482
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Authorized Official
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Title or Position | DIRECTOR
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Name | MICHAEL SCHAAF
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Credential |
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Telephone | 269-217-6442
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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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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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