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General NPI Number Information
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NPI Number | 1982868352
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Entity Type | Organization
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Legal Business Name | SMILE BUILDERS PLLC
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 32749 FRANKLIN RD
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City | FRANKLIN
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State | MI
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Zip | 48025
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Country | US
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Telephone | 248-626-6635
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Fax | 248-626-6635
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Provider Business Mailing Address
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Address Line | 32749 FRANKLIN RD
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City | FRANKLIN
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State | MI
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Zip | 48025-1122
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Country | US
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Telephone | 248-626-6635
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Fax | 248-539-0303
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. MARY RAVEANE
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Credential |
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Telephone | 248-626-6635
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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 | 014041
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License Number State | MI
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