MEDICARE: SMILEGUYS, PLLC

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	16113	MI
2	122300000X	Dentist	16735	MI

General Provider Information

NPI Number	:	1265763296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILEGUYS, PLLC

Provider Business Mailing Address
First Line	:	4044 24TH AVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3800
Country	:	US
Telephone Number	:	810-385-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 MICHIGAN AVE
Second Line	:	SUITE B
City	:	MARYSVILLE
State	:	MI
Zip	:	48040-2112
Country	:	US
Telephone Number	:	810-364-9300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. W. SCOTT MEYER
Credential	:
Telephone Number	:	810-385-2273

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	01/14/2010

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