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General NPI Number Information
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NPI Number | 1821770520
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Entity Type | Organization
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Legal Business Name | ELITE SMILE FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 17043 RIDGE RD
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City | NORTHVILLE
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State | MI
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Zip | 48168-9555
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Country | US
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Telephone | 734-709-6861
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Fax |
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Provider Business Mailing Address
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Address Line | 21312 SUMMERBREEZE DR
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City | NORTHVILLE
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State | MI
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Zip | 48167-1867
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Country | US
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Telephone | 734-709-6861
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TOSHA M PATEL
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Credential |
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Telephone | 734-709-6861
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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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