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General NPI Number Information
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NPI Number | 1679777171
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Entity Type | Organization
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Legal Business Name | SMILE CENTERS PC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 4000 LIVERNOIS RD STE 100
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City | TROY
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State | MI
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Zip | 48098-4712
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Country | US
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Telephone | 248-813-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 LIVERNOIS RD # 100
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City | TROY
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State | MI
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Zip | 48098-4712
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Country | US
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Telephone | 248-813-7700
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SIRISHA NEMALLAPUDI
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Credential | D.M.D
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Telephone | 248-813-7700
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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 | 2901017598
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License Number State | MI
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