MEDICARE: ELITE SMILE

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
1	122300000X	Dentist	2901018547	MI

General Provider Information

NPI Number	:	1215476387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE SMILE

Provider Business Mailing Address
First Line	:	714 PATRICIA PLACE DR
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-3895
Country	:	US
Telephone Number	:	734-502-6663
Fax Number	:

Provider Business Practice Location Address
First Line	:	714 PATRICIA PLACE DR
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-3895
Country	:	US
Telephone Number	:	734-502-6663
Fax Number	:

Authorized Official
Title or Position	:	DESNTIST
Name	:	DR. NIDA ALSHAIKH
Credential	:	DDS
Telephone Number	:	734-502-6663

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	02/21/2017

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Directions to “ELITE SMILE ” Practice Location

Language	Start Address	Practice Location

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