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NPI Code Detail

MEDICARE: SMILEY DENTAL PC

MEDICARE: SMILEY DENTAL PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist17136MI

General Provider Information

NPI Number : 1033498035
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMILEY DENTAL PC
Provider Business Mailing Address
First Line : 15510 LIVERNOIS AVE
Second Line :
City : DETROIT
State : MI
Zip : 48238-1343
Country : US
Telephone Number : 313-863-2800
Fax Number : 313-863-5054
Provider Business Practice Location Address
First Line : 15510 LIVERNOIS AVE
Second Line :
City : DETROIT
State : MI
Zip : 48238-1343
Country : US
Telephone Number : 313-863-2800
Fax Number : 313-863-5054
Authorized Official
Title or Position : OWNER
Name : ROSEMARY PITARO
Credential :
Telephone Number : 313-863-2800
Provider Enumeration Date : 08/08/2011
Last Update Date : 08/08/2011

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Directions to “SMILEY DENTAL PC ” Practice Location

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