1386935203 NPI number — SPECIAL SMILES PEDIATRIC DENTISTRY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386935203 NPI number — SPECIAL SMILES PEDIATRIC DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIAL SMILES PEDIATRIC DENTISTRY
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:
6
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:
1386935203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10801 N MICHIGAN RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
ZIONSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46077-8170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-873-3448
Provider Business Mailing Address Fax Number:
317-873-3425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10801 N MICHIGAN RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ZIONSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46077-8170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-873-3448
Provider Business Practice Location Address Fax Number:
317-873-3425
Provider Enumeration Date:
04/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SATTERFIELD-SIEGEL
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
CEO/PEDIATRIC DENTIST
Authorized Official Telephone Number:
317-873-3448

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  12009492A , 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)





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