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General NPI Number Information
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NPI Number | 1912255928
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Entity Type | Organization
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Legal Business Name | SMILES OF TOMORROW, P.C.
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Dates
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Enumeration Date | 08/22/2012
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Last Update Date | 08/22/2012
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Provider Practice Location Address
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Address Line | 645 GRISWOLD ST ST 224
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City | DETROIT
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State | MI
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Zip | 48226-4105
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Country | US
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Telephone | 734-707-9115
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Fax |
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Provider Business Mailing Address
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Address Line | 1959 E 166TH PL
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2666
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Country | US
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Telephone | 248-431-4954
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Fax | 708-895-2161
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. MICHAEL STEVEN HENDERSON
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Credential | D.D.S.
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Telephone | 248-431-4954
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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 | 2901017049
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License Number State | MI
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