1437398534 NPI number — S K PESIS DDS, BIG SMILES MARYLAND, PC

Table of content: (NPI 1437398534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437398534 NPI number — S K PESIS DDS, BIG SMILES MARYLAND, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S K PESIS DDS, BIG SMILES MARYLAND, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437398534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33533 W 12 MILE RD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48331-3354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-833-8441
Provider Business Mailing Address Fax Number:
888-330-4331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 EAST PRATT STREET
Provider Second Line Business Practice Location Address:
8TH FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-833-8441
Provider Business Practice Location Address Fax Number:
888-330-4331
Provider Enumeration Date:
02/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PESIS
Authorized Official First Name:
SOLOMON
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
888-833-8441

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  14344 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com