=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861899023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL SMILES DENTAL GROUP, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2014
-----------------------------------------------------
Last Update Date | 12/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2820 BAKER RD SUITE 200
-----------------------------------------------------
City | DEXTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48130-1181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-426-1580
-----------------------------------------------------
Fax | 734-426-1590
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 TAYLOR ST SUITE A
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | KELLY ANN SCHERR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 734-426-1580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 15648
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------