Healthcare Provider Details

I. General information

NPI: 1114735669
Provider Name (Legal Business Name): BREATHE AND SMILE STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2046 DORCHESTER CT
GOSHEN IN
46526-6534
US

IV. Provider business mailing address

2046 DORCHESTER CT
GOSHEN IN
46526-6534
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-2469
  • Fax: 574-537-1791
Mailing address:
  • Phone: 574-533-2469
  • Fax: 574-537-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. GABRIELLE M. JOHNSON
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 574-533-2469