Provider Demographics
NPI:1932749314
Name:IMPRESSIVE SMILE FAMILY DENTISTRY, DDS, PLLC
Entity Type:Organization
Organization Name:IMPRESSIVE SMILE FAMILY DENTISTRY, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REEM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-ABBOUSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-565-1862
Mailing Address - Street 1:25711 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2046
Mailing Address - Country:US
Mailing Address - Phone:313-565-1862
Mailing Address - Fax:313-562-5428
Practice Address - Street 1:25711 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2046
Practice Address - Country:US
Practice Address - Phone:313-565-1862
Practice Address - Fax:313-562-5428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental