Provider Demographics
NPI:1063982965
Name:SMILE CLINIC MOBILE DENTISTRY PC
Entity type:Organization
Organization Name:SMILE CLINIC MOBILE DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BELLEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-388-7720
Mailing Address - Street 1:17007 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2451
Mailing Address - Country:US
Mailing Address - Phone:313-388-7720
Mailing Address - Fax:313-388-8161
Practice Address - Street 1:17007 ECORSE RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2451
Practice Address - Country:US
Practice Address - Phone:313-388-7720
Practice Address - Fax:313-388-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental