Provider Demographics
NPI:1508596859
Name:LIFESMILES PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:LIFESMILES PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CZARNECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-518-8620
Mailing Address - Street 1:2775 E GRAND RIVER AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8532
Mailing Address - Country:US
Mailing Address - Phone:517-518-8620
Mailing Address - Fax:
Practice Address - Street 1:2775 E GRAND RIVER AVE STE 3
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8532
Practice Address - Country:US
Practice Address - Phone:517-518-8620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty