Organization
INDY WEST SMILES YOUTH DENTISTRY, LLC
Active
Other names
Prime Smile West
Organization subpart
No
Provider details
NPI number
Authorized official
HELEN K. PETERSON DDS (OWNER)
(317) 925-2810
Entity
Organization
Contact information
Practice address
2802 LAFAYETTE ROAD, SUITE 33, INDIANAPOLIS, IN 46222
(317) 925-2810
Mailing address
2802 LAFAYETTE ROAD, SUITE 33, INDIANAPOLIS, IN 46222
(317) 925-2810
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200434530A
—
IN
Enumeration date
06/19/2006
Last updated
07/01/2019
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