Organization
SUMMIT CITY SMILES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER PAUL VALLIERE D.D.S. (PRESIDENT)
(260) 484-5614
Entity
Organization
Contact information
Practice address
1330 E STATE BLVD, FORT WAYNE, IN 46805-4422
(260) 484-5614
Mailing address
1330 E STATE BLVD, FORT WAYNE, IN 46805-4422
(260) 484-5614
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/20/2015
Last updated
08/20/2015
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