Provider Demographics
NPI:1477163939
Name:SMILE FRESH PC
Entity type:Organization
Organization Name:SMILE FRESH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANGER
Authorized Official - Prefix:
Authorized Official - First Name:FAUZI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZIUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-603-3368
Mailing Address - Street 1:500 PERRY RD # 205
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1482
Mailing Address - Country:US
Mailing Address - Phone:810-603-3368
Mailing Address - Fax:810-771-7364
Practice Address - Street 1:500 PERRY RD # 205
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1482
Practice Address - Country:US
Practice Address - Phone:810-603-3368
Practice Address - Fax:810-771-7364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty