Provider Demographics
NPI:1780835975
Name:ADVANCED SMILE DESIGN, INC.
Entity Type:Organization
Organization Name:ADVANCED SMILE DESIGN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAIGH
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:906-265-0050
Mailing Address - Street 1:528 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-1402
Mailing Address - Country:US
Mailing Address - Phone:906-265-0050
Mailing Address - Fax:906-265-0069
Practice Address - Street 1:528 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-1402
Practice Address - Country:US
Practice Address - Phone:906-265-0050
Practice Address - Fax:906-265-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010107291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10729Medicaid