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General NPI Number Information
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NPI Number | 1891174769
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Entity Type | Organization
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Legal Business Name | BIG SMILES MOBILE DENTISTS DELAWARE P.A.
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 1000 N WEST ST SUITE 1200
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City | WILMINGTON
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State | DE
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Zip | 19801-1050
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Country | US
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Telephone | 888-833-8441
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Fax | 888-330-4331
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Provider Business Mailing Address
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Address Line | 33533 W 12 MILE RD SUITE 150
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-3354
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Country | US
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Telephone | 888-833-8441
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Fax | 888-330-4331
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | CHRISTINE FOX
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Credential | DMD
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Telephone | 888-833-8441
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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 | G10001246
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License Number State | DE
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