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Organization
PORTABLE SMILES LLC
Active
Organization
PORTABLE SMILES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA JOHNSON (MANAGER)
(313) 790-0094
Entity
Organization
Contact information
Practice address
141 S LAGUNA POINTE DR, LEAGUE CITY, TX 77573-9004
(734) 260-2601
Mailing address
519 PINEHURST DR, CANTON, MI 48188-3078
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/11/2017
Last updated
09/11/2017
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