MEDICARE: JUST RIGHT SMILES LLC

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	:	1932731114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUST RIGHT SMILES LLC

Provider Business Mailing Address
First Line	:	5460 PONTIAC TRL
Second Line	:
City	:	ORCHARD LAKE
State	:	MI
Zip	:	48323-1564
Country	:	US
Telephone Number	:	954-732-8923
Fax Number	:

Provider Business Practice Location Address
First Line	:	11200 E MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-3929
Country	:	US
Telephone Number	:	313-521-6400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAVEN DURHAM
Credential	:	DDS
Telephone Number	:	954-732-8923

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	02/06/2020

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Directions to “JUST RIGHT SMILES LLC ” Practice Location

Language	Start Address	Practice Location

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