Provider Demographics
NPI:1043581606
Name:SMILE FOREVER ORTHODONTICS
Entity Type:Organization
Organization Name:SMILE FOREVER ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:517-223-3779
Mailing Address - Street 1:175 E VAN RIPER RD
Mailing Address - Street 2:BOX 945
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-8942
Mailing Address - Country:US
Mailing Address - Phone:517-223-4496
Mailing Address - Fax:
Practice Address - Street 1:175 E VAN RIPER RD
Practice Address - Street 2:BOX 945
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-8942
Practice Address - Country:US
Practice Address - Phone:517-223-4496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010201301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty