Provider Demographics
NPI:1568538601
Name:SMITH, DREW MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12319 HIGHLAND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353
Mailing Address - Country:US
Mailing Address - Phone:810-632-6444
Mailing Address - Fax:810-632-6491
Practice Address - Street 1:12319 HIGHLAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353
Practice Address - Country:US
Practice Address - Phone:810-632-6444
Practice Address - Fax:810-632-6491
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010185111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice