Provider Demographics
NPI:1902572712
Name:LIVONIA SMILES DENTAL CENTER
Entity Type:Organization
Organization Name:LIVONIA SMILES DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:THARWAT
Authorized Official - Last Name:ESSAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:248-477-5888
Mailing Address - Street 1:18224 FARMINGTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4445
Mailing Address - Country:US
Mailing Address - Phone:248-477-5888
Mailing Address - Fax:248-477-6679
Practice Address - Street 1:18224 FARMINGTON RD STE A
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4445
Practice Address - Country:US
Practice Address - Phone:248-477-5888
Practice Address - Fax:248-477-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1073997441Medicaid