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Organization
INDY WEST SMILES YOUTH DENTISTRY, LLC
Active
Organization
INDY WEST SMILES YOUTH DENTISTRY, LLC
Active
Other names
Prime Smile West
Organization subpart
No
Provider details
NPI number
Authorized official
HELEN K. PETERSON DDS (OWNER)
(317) 925-2810
Entity
Organization
Contact information
Practice address
2802 LAFAYETTE ROAD, SUITE 33, INDIANAPOLIS, IN 46222
(317) 925-2810
Mailing address
2802 LAFAYETTE ROAD, SUITE 33, INDIANAPOLIS, IN 46222
(317) 925-2810
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200434530A
—
IN
Enumeration date
06/19/2006
Last updated
07/01/2019
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