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NPI Code Detail

MEDICARE: GREAT SMILE DENTAL PC

MEDICARE: GREAT SMILE DENTAL PC
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
1122300000XDentist12010607AIN

General Provider Information

NPI Number : 1861666851
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREAT SMILE DENTAL PC
Provider Business Mailing Address
First Line : 4200 S EAST ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1534
Country : US
Telephone Number : 317-787-1320
Fax Number :
Provider Business Practice Location Address
First Line : 4200 S EAST ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1534
Country : US
Telephone Number : 317-787-1320
Fax Number :
Authorized Official
Title or Position : OFFICER
Name : DR. SHAWN CABBELL
Credential : DDS
Telephone Number : 317-361-2745
Provider Enumeration Date : 04/21/2008
Last Update Date : 04/21/2008

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Directions to “GREAT SMILE DENTAL PC ” Practice Location

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