Provider Demographics
NPI:1174243018
Name:SMILES OF MICHIGAN, PC
Entity type:Organization
Organization Name:SMILES OF MICHIGAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ-CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-381-9999
Mailing Address - Street 1:2104 JOLLY RD STE 260
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-6038
Mailing Address - Country:US
Mailing Address - Phone:517-381-9999
Mailing Address - Fax:517-381-0920
Practice Address - Street 1:2104 JOLLY RD STE 260
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6038
Practice Address - Country:US
Practice Address - Phone:517-381-9999
Practice Address - Fax:517-381-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental