Organization
SOUTH SHORE SMILES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER K SHIEH DDS (OWNER)
(219) 716-1259
Entity
Organization
Contact information
Practice address
9270 WICKER AVE, SUITE E AND F, SAINT JOHN, IN 46373-8508
(219) 627-3133
Mailing address
9270 WICKER AVE, SUITE E AND F, SAINT JOHN, IN 46373-8508
(219) 627-3133
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011455A
IN
1223P0221X
Pediatric Dentistry
12011456A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144540980
—
IN
05
—
1184944159
—
IN
Enumeration date
09/09/2016
Last updated
09/09/2016
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