# INDY EAST SMILES YOUTH DENTISTRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prime Smile East
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013952696
- **Authorized official:** HELEN K. PETERSON DDS (OWNER)
- **Authorized official phone:** (317) 322-1840

## Contact information

- **Practice address:** 5430 EAST WASHINGTON STREET, SUITE 101, INDIANAPOLIS, IN 46219
- **Practice address phone:** (317) 322-1840
- **Practice address fax:** (615) 986-1705
- **Mailing address:** 5430 EAST WASHINGTON STREET, SUITE 101, INDIANAPOLIS, IN 46219
- **Mailing address phone:** (317) 322-1840
- **Mailing address fax:** (615) 986-1705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 06/18/2006
- **Last updated:** 06/24/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200361860A | — | IN |