Provider Demographics
NPI:1659771509
Name:HEALTHY SMILES DENTAL CARE OF DEXTER
Entity Type:Organization
Organization Name:HEALTHY SMILES DENTAL CARE OF DEXTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ONEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-726-7644
Mailing Address - Street 1:9477 N TERRITORIAL RD
Mailing Address - Street 2:STE 130
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-8583
Mailing Address - Country:US
Mailing Address - Phone:734-726-7644
Mailing Address - Fax:734-629-4143
Practice Address - Street 1:9477 N TERRITORIAL RD
Practice Address - Street 2:STE 130
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-8583
Practice Address - Country:US
Practice Address - Phone:734-726-7644
Practice Address - Fax:734-629-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty