1689837940 NPI number — RLI DENTAL, LLC

Table of content: (NPI 1689837940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689837940 NPI number — RLI DENTAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RLI DENTAL, LLC
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:
SIMPLY SMILE
Provider Other Organization Name Type Code:
3
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:
1689837940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7340 CROSSING PL
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FISHERS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46038-2785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-570-5480
Provider Business Mailing Address Fax Number:
317-570-5481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7340 CROSSING PL
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FISHERS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46038-2785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-570-5480
Provider Business Practice Location Address Fax Number:
317-570-5481
Provider Enumeration Date:
07/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NEMSER
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
317-570-5480

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12010486A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200402720A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com