Healthcare Provider Details

I. General information

NPI: 1134438104
Provider Name (Legal Business Name): TRUELOVE SMILES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 HARRISON ST STE 125
MERRILLVILLE IN
46410-2969
US

IV. Provider business mailing address

6111 HARRISON ST STE 125
MERRILLVILLE IN
46410-2969
US

V. Phone/Fax

Practice location:
  • Phone: 219-980-4566
  • Fax: 219-980-1050
Mailing address:
  • Phone: 219-980-4566
  • Fax: 219-980-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12005843A
License Number StateIN

VIII. Authorized Official

Name: DR. KESLER E TRUELOVE III
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 219-980-4566