Healthcare Provider Details

I. General information

NPI: 1841117736
Provider Name (Legal Business Name): SMILE HAUS DENTAL STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10108 MONDORF ST STE C&D
DYER IN
46311-0059
US

IV. Provider business mailing address

10108 MONDORF ST STE C&D
DYER IN
46311-0059
US

V. Phone/Fax

Practice location:
  • Phone: 219-377-6453
  • Fax: 219-207-8005
Mailing address:
  • Phone: 219-377-6453
  • Fax: 219-207-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SIMON ABU-AITA
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 219-805-9914