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General NPI Number Information
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NPI Number | 1912814765
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Entity Type | Organization
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Legal Business Name | SOUTH LYON PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 08/26/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 26808 PONTIAC TRAIL
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City | SOUTH LYON
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State | MI
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Zip | 48178
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Country | US
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Telephone | 857-272-2572
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Fax |
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Provider Business Mailing Address
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Address Line | 51019 SILVERTON
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City | CANTON
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State | MI
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Zip | 48187-7719
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. MARIA AL ISMAIL
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Credential | DDS
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Telephone | 734-926-8428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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