# INDY WEST SMILES YOUTH DENTISTRY, LLC

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

## Provider details

- **NPI number:** 1134164445
- **Authorized official:** HELEN K. PETERSON DDS (OWNER)
- **Authorized official phone:** (317) 925-2810

## Contact information

- **Practice address:** 2802 LAFAYETTE ROAD, SUITE 33, INDIANAPOLIS, IN 46222
- **Practice address phone:** (317) 925-2810
- **Mailing address:** 2802 LAFAYETTE ROAD, SUITE 33, INDIANAPOLIS, IN 46222
- **Mailing address phone:** (317) 925-2810

## Taxonomy

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

## Other

- **Enumeration date:** 06/19/2006
- **Last updated:** 07/01/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200434530A | — | IN |