# SOUTH SHORE SMILES LLC

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

## Provider details

- **NPI number:** 1356898050
- **Authorized official:** DR. ROGER K SHIEH DDS (OWNER)
- **Authorized official phone:** (219) 716-1259

## Contact information

- **Practice address:** 9270 WICKER AVE, SUITE E AND F, SAINT JOHN, IN 46373-8508
- **Practice address phone:** (219) 627-3133
- **Mailing address:** 9270 WICKER AVE, SUITE E AND F, SAINT JOHN, IN 46373-8508
- **Mailing address phone:** (219) 627-3133

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12011455A | IN | Yes |
| 1223P0221X | Pediatric Dentistry | 12011456A | IN | — |

## Other

- **Enumeration date:** 09/09/2016
- **Last updated:** 09/09/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1144540980 | — | IN |
| 05 | — | 1184944159 | — | IN |