MEDICARE: GLOBAL SMILES DENTAL 13 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1558184127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBAL SMILES DENTAL 13 LLC

Provider Business Mailing Address
First Line	:	10706 E US HIGHWAY 36
Second Line	:
City	:	AVON
State	:	IN
Zip	:	46123-7982
Country	:	US
Telephone Number	:	317-956-5035
Fax Number	:

Provider Business Practice Location Address
First Line	:	3269 W 86TH ST STE A2
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3822
Country	:	US
Telephone Number	:	317-830-0404
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING ASSOCIATE
Name	:	TIA WHITE
Credential	:
Telephone Number	:	317-830-0404

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/11/2025

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