Provider Demographics
NPI:1477134112
Name:SMILE ZONE PLLC
Entity Type:Organization
Organization Name:SMILE ZONE PLLC
Other - Org Name:SMILE ZONE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-217-6442
Mailing Address - Street 1:5290 W BROOKSHIRE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3794
Mailing Address - Country:US
Mailing Address - Phone:734-242-3311
Mailing Address - Fax:734-242-6482
Practice Address - Street 1:5290 BROOKSHIRE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161
Practice Address - Country:US
Practice Address - Phone:734-242-3311
Practice Address - Fax:734-242-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty