=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508069907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNNY SMILES P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30060 23 MILE RD
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48047-5718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-949-2240
-----------------------------------------------------
Fax | 586-949-2243
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30060 23 MILE RD
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48047-5718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-949-2240
-----------------------------------------------------
Fax | 586-949-2243
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | KAREN L LENARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 586-949-2240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2901017682
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------