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General NPI Number Information
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NPI Number | 1922618487
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Entity Type | Organization
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Legal Business Name | SMILE FRESH AH PC
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Dates
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Enumeration Date | 08/08/2020
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Last Update Date | 08/08/2020
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Provider Practice Location Address
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Address Line | 3231 SOUTH BLVD
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City | AUBURN HILLS
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State | MI
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Zip | 48326-3635
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Country | US
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Telephone | 248-255-4585
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Fax | 248-731-5634
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Provider Business Mailing Address
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Address Line | 3231 SOUTH BLVD
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City | AUBURN HILLS
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State | MI
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Zip | 48326-3635
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Country | US
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Telephone | 248-255-4585
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Fax | 248-731-5634
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Authorized Official
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Title or Position | MANAGER
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Name | MR. FAUZI RAZIUDDIN
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Credential |
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Telephone | 248-255-4585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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