Provider Demographics
NPI:1982868352
Name:SMILE BUILDERS PLLC
Entity Type:Organization
Organization Name:SMILE BUILDERS PLLC
Other - Org Name:SMILE BUILDERS OF FRANKLIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVEANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-626-6635
Mailing Address - Street 1:32749 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1122
Mailing Address - Country:US
Mailing Address - Phone:248-626-6635
Mailing Address - Fax:248-539-0303
Practice Address - Street 1:32749 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-626-6635
Practice Address - Fax:248-626-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0140411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID