MEDICARE: SMILE STUDIO OF FARMINGTON HILLS, 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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1487242384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE STUDIO OF FARMINGTON HILLS, PC

Provider Business Mailing Address
First Line	:	14755 NORTHLINE RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2407
Country	:	US
Telephone Number	:	734-281-0880
Fax Number	:

Provider Business Practice Location Address
First Line	:	32931 MIDDLEBELT RD STE 612
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-1772
Country	:	US
Telephone Number	:	248-626-9915
Fax Number	:	248-851-0843

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. DAVID SORIAL
Credential	:	DDS
Telephone Number	:	248-229-2274

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/13/2021

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