Provider Demographics
NPI:1437920170
Name:GREAT LAKES SMILES
Entity Type:Organization
Organization Name:GREAT LAKES SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAHAF
Authorized Official - Middle Name:
Authorized Official - Last Name:HALIMEH-SUEDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-295-2854
Mailing Address - Street 1:40400 ANN ARBOR RD E STE 202B
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6613
Mailing Address - Country:US
Mailing Address - Phone:734-459-9360
Mailing Address - Fax:
Practice Address - Street 1:37683 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1050
Practice Address - Country:US
Practice Address - Phone:734-542-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental