Provider Demographics
NPI:1033498035
Name:SMILEY DENTAL PC
Entity Type:Organization
Organization Name:SMILEY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PITARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-863-2800
Mailing Address - Street 1:15510 LIVERNOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-1343
Mailing Address - Country:US
Mailing Address - Phone:313-863-2800
Mailing Address - Fax:313-863-5054
Practice Address - Street 1:15510 LIVERNOIS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1343
Practice Address - Country:US
Practice Address - Phone:313-863-2800
Practice Address - Fax:313-863-5054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty