MEDICARE: SIGNATURE SMILES BRIGHTON 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1518585009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIGNATURE SMILES BRIGHTON PLLC

Provider Business Mailing Address
First Line	:	8130 GRAND RIVER RD
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-9376
Country	:	US
Telephone Number	:	810-224-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	8130 GRAND RIVER RD
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-9376
Country	:	US
Telephone Number	:	810-224-5600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY SOLOMON
Credential	:
Telephone Number	:	810-224-5600

Provider Enumeration Date	:	07/10/2020
Last Update Date	:	07/10/2020

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