Provider Demographics
NPI:1629655469
Name:DEARBORN FAMILY SMILES PLLC
Entity Type:Organization
Organization Name:DEARBORN FAMILY SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE DEVELOPMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-525-6100
Mailing Address - Street 1:16979 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2946
Mailing Address - Country:US
Mailing Address - Phone:734-525-6100
Mailing Address - Fax:
Practice Address - Street 1:5005 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3252
Practice Address - Country:US
Practice Address - Phone:313-914-2595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty