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NPI Code Detail

MEDICARE: SMILE DENTAL HAMTRAMACK PLLC

MEDICARE: SMILE DENTAL HAMTRAMACK 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
11223D0001XPublic Health Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11134568868OTHERMINPI

General Provider Information

NPI Number : 1851980486
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMILE DENTAL HAMTRAMACK PLLC
Provider Business Mailing Address
First Line : 9411 JOSEPH CAMPAU ST
Second Line :
City : HAMTRAMCK
State : MI
Zip : 48212-3435
Country : US
Telephone Number : 313-398-4269
Fax Number :
Provider Business Practice Location Address
First Line : 9411 JOSEPH CAMPAU ST
Second Line :
City : HAMTRAMCK
State : MI
Zip : 48212-3435
Country : US
Telephone Number : 313-398-4269
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : FEDEL ALI
Credential :
Telephone Number : 313-398-4269
Provider Enumeration Date : 01/18/2021
Last Update Date : 01/18/2021

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Directions to “SMILE DENTAL HAMTRAMACK PLLC ” Practice Location

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