# ELITE SMILES DENTAL, LLC

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

## Provider details

- **NPI number:** 1427628684
- **Authorized official:** SHELBEY MAYHEW (CONTROLLER)
- **Authorized official phone:** (812) 234-7322

## Contact information

- **Practice address:** 1024 LAFAYETTE AVE, TERRE HAUTE, IN 47804-2932
- **Practice address phone:** (812) 234-7322
- **Mailing address:** 1107 OHIO ST, TERRE HAUTE, IN 47807-3817
- **Mailing address phone:** (812) 234-7322

## Taxonomy

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

## Other

- **Enumeration date:** 06/30/2021
- **Last updated:** 06/30/2021