Provider Demographics
NPI:1063890820
Name:BRUCE A SMOLER DDS PLLC
Entity type:Organization
Organization Name:BRUCE A SMOLER DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMOLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-728-5600
Mailing Address - Street 1:820 N WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3632
Mailing Address - Country:US
Mailing Address - Phone:734-728-5600
Mailing Address - Fax:734-728-1656
Practice Address - Street 1:820 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3632
Practice Address - Country:US
Practice Address - Phone:734-728-5600
Practice Address - Fax:734-728-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty