=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942511316
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL SMILES DENTAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2010
-----------------------------------------------------
Last Update Date | 06/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 TAYLOR ST SUITE A
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-475-7303
-----------------------------------------------------
Fax | 734-433-4270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 TAYLOR ST SUITE A
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-475-7303
-----------------------------------------------------
Fax | 734-433-4270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST OWNER
-----------------------------------------------------
Name | KELLY ANN SCHERR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 734-475-7303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 1518029883
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 2901018078
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 11558425488
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------