Provider Demographics
NPI:1275809162
Name:SMILE AMERICA
Entity Type:Organization
Organization Name:SMILE AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIDAA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-478-0900
Mailing Address - Street 1:30890 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2606
Mailing Address - Country:US
Mailing Address - Phone:248-939-1801
Mailing Address - Fax:
Practice Address - Street 1:30890 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2606
Practice Address - Country:US
Practice Address - Phone:248-939-1801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty