South Bend Smiles Youth Dentistry, Llc

LBN: South Bend Smiles Youth Dentistry, Llc
South Bend Smiles Youth Dentistry, Llc is an health care organization with primary practice located at 2332 Miracle Ln , Mishawaka IN 46545-3012. The organization recently has only one registered license in Dental Providers / General Practice, which is considered as the primary health care specialty. South Bend Smiles Youth Dentistry, Llc can be contacted via phone (574) 259-5437, or through Stump, Jenell via phone (615) 750-0343.

Contact Information

Primary practice address
2332 Miracle Ln Mishawaka IN 46545-3012
Phone: (574) 259-5437
Fax: (574) 259-5438
Website:
Map and Directions
Authorized official contact:
Name: Stump, Jenell
Phone: (615) 750-0343

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X

Profile Details

NPI number 1902017593
LBN Legal business name South Bend Smiles Youth Dentistry, Llc
DBA Doing business as
Authorized official Stump, Jenell
Entity Organization
Organization subpart 1 No
Enumeration date May 24th, 2007
Last updated Jul 9th, 2014 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902017593 NPPES
Indiana MEDICAID 200828710A
Indiana MEDICAID 1902017593

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