# KIDS SMILE INNOVATIONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Kid's Smile Place
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619308566
- **Authorized official:** MS. APRIL D SPIVEY (PRACTICE MANAGER)
- **Authorized official phone:** (767) 617-4750

## Contact information

- **Practice address:** 5129 CLINTON DR, KOKOMO, IN 46902-7136
- **Practice address phone:** (765) 617-4750
- **Mailing address:** 110 SUMMERS DR, TIPTON, IN 46072-8696
- **Mailing address phone:** (765) 617-4750

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12008126A | IN | Yes |

## Other

- **Enumeration date:** 12/03/2013
- **Last updated:** 12/03/2013