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General NPI Number Information
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NPI Number | 1841529609
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILES DENTAL CARE LLC
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 227 E MAIN ST
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City | MANCHESTER
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State | MI
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Zip | 48158-9312
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Country | US
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Telephone | 734-428-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 227 E MAIN ST
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City | MANCHESTER
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State | MI
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Zip | 48158-9312
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Country | US
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Telephone | 734-428-8000
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | STEVEN RODRIGUEZ
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Credential |
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Telephone | 734-475-8911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 015703
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License Number State | MI
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