Provider Demographics
NPI:1023404068
Name:PORTABLE SMILES CONSULTING LLC
Entity type:Organization
Organization Name:PORTABLE SMILES CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STERLING
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-260-2601
Mailing Address - Street 1:41962 TRENT CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-5208
Mailing Address - Country:US
Mailing Address - Phone:734-260-2601
Mailing Address - Fax:
Practice Address - Street 1:41962 TRENT CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-5208
Practice Address - Country:US
Practice Address - Phone:734-260-2601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty