Organization
INDY EAST SMILES YOUTH DENTISTRY LLC
Active
Other names
Prime Smile East
Organization subpart
No
Provider details
NPI number
Authorized official
HELEN K. PETERSON DDS (OWNER)
(317) 322-1840
Entity
Organization
Contact information
Practice address
5430 EAST WASHINGTON STREET, SUITE 101, INDIANAPOLIS, IN 46219
(317) 322-1840
(615) 986-1705
Mailing address
5430 EAST WASHINGTON STREET, SUITE 101, INDIANAPOLIS, IN 46219
(317) 322-1840
(615) 986-1705
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200361860A
—
IN
Enumeration date
06/18/2006
Last updated
06/24/2019
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