Organization
CREATE-A-SMILE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANNON KENNETH MOORE DMD, MSED (OWNER)
(812) 332-1405
Entity
Organization
Contact information
Practice address
2815 N WALNUT ST, BLOOMINGTON, IN 47404-2077
(812) 332-1405
(812) 332-4331
Mailing address
2815 N WALNUT ST, BLOOMINGTON, IN 47404-2077
(812) 332-1405
(812) 332-4331
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12010311A
IN
122300000X
Dentist
12011246A
IN
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194855205
NPI
IN
05
—
200326230
—
IN
Enumeration date
01/20/2010
Last updated
05/17/2022
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us