Provider Demographics
NPI:1346015336
Name:SMILE FRESH TROY, P.C.
Entity Type:Organization
Organization Name:SMILE FRESH TROY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FAUZI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZIUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-906-8805
Mailing Address - Street 1:1059 OWENDALE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1913
Mailing Address - Country:US
Mailing Address - Phone:248-906-8805
Mailing Address - Fax:
Practice Address - Street 1:1059 OWENDALE DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1913
Practice Address - Country:US
Practice Address - Phone:248-906-8805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty