Provider Demographics
NPI:1639414626
Name:PRETTYSMILESDENTURESANDMORELLC
Entity Type:Organization
Organization Name:PRETTYSMILESDENTURESANDMORELLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1313-362-2222
Mailing Address - Street 1:19123 WEST MCNICHOLS
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219
Mailing Address - Country:US
Mailing Address - Phone:313-362-2222
Mailing Address - Fax:
Practice Address - Street 1:19123 WEST MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:40219
Practice Address - Country:US
Practice Address - Phone:131-336-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty