Provider Demographics
NPI:1841982626
Name:SMILE ENVY PLLC
Entity type:Organization
Organization Name:SMILE ENVY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ODETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAOUILOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-354-3903
Mailing Address - Street 1:19 RIVERBANK DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4802
Mailing Address - Country:US
Mailing Address - Phone:586-354-3903
Mailing Address - Fax:
Practice Address - Street 1:30969 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1338
Practice Address - Country:US
Practice Address - Phone:586-354-3903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty