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General NPI Number Information
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NPI Number | 1932731114
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Entity Type | Organization
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Legal Business Name | JUST RIGHT SMILES LLC
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 11200 E MCNICHOLS RD
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City | DETROIT
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State | MI
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Zip | 48234-3929
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Country | US
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Telephone | 313-521-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 5460 PONTIAC TRL
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City | ORCHARD LAKE
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State | MI
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Zip | 48323-1564
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Country | US
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Telephone | 954-732-8923
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAVEN DURHAM
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Credential | DDS
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Telephone | 954-732-8923
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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 |
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License Number State |
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