Provider Demographics
NPI:1730647272
Name:EPIC SMILE CENTERS OF MICHIGAN PLLC
Entity type:Organization
Organization Name:EPIC SMILE CENTERS OF MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-866-3040
Mailing Address - Street 1:17968 FIELDBROOK CIR S
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1531
Mailing Address - Country:US
Mailing Address - Phone:561-866-3040
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:866-374-2764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1770628687OtherDENTIST