Provider Demographics
NPI:1831276799
Name:SMARGON, MITCHEL DAVID (DDS)
Entity type:Individual
Prefix:
First Name:MITCHEL
Middle Name:DAVID
Last Name:SMARGON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 TAMERLANE
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-879-5557
Mailing Address - Fax:248-879-4548
Practice Address - Street 1:6535 ROCHESTER ROAD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:98085
Practice Address - Country:US
Practice Address - Phone:248-879-5557
Practice Address - Fax:248-879-4548
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist