Provider Demographics
NPI:1396048021
Name:SMILE CARE DENTAL PC
Entity type:Organization
Organization Name:SMILE CARE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-582-1919
Mailing Address - Street 1:14350 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1459
Mailing Address - Country:US
Mailing Address - Phone:313-582-1919
Mailing Address - Fax:313-582-0300
Practice Address - Street 1:14350 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1459
Practice Address - Country:US
Practice Address - Phone:313-582-1919
Practice Address - Fax:313-582-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty