# SUMMIT CITY SMILES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083080386
- **Authorized official:** DR. ROGER PAUL VALLIERE D.D.S. (PRESIDENT)
- **Authorized official phone:** (260) 484-5614

## Contact information

- **Practice address:** 1330 E STATE BLVD, FORT WAYNE, IN 46805-4422
- **Practice address phone:** (260) 484-5614
- **Mailing address:** 1330 E STATE BLVD, FORT WAYNE, IN 46805-4422
- **Mailing address phone:** (260) 484-5614

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 08/20/2015
- **Last updated:** 08/20/2015