Provider Demographics
NPI:1912255928
Name:SMILES OF TOMORROW, P.C.
Entity Type:Organization
Organization Name:SMILES OF TOMORROW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-431-4954
Mailing Address - Street 1:1959 E 166TH PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2666
Mailing Address - Country:US
Mailing Address - Phone:248-431-4954
Mailing Address - Fax:708-895-2161
Practice Address - Street 1:645 GRISWOLD ST
Practice Address - Street 2:ST 224
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-4105
Practice Address - Country:US
Practice Address - Phone:734-707-9115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017049261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental