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General NPI Number Information
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NPI Number | 1356086276
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Entity Type | Organization
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Legal Business Name | SERENITY SMILE CARE, LLC
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 322 N. INDIANA AVE
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City | SELLERSBURG
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State | IN
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Zip | 47172
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Country | US
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Telephone | 313-204-4775
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Fax |
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Provider Business Mailing Address
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Address Line | 11902 MEMORY RUN PL
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City | LOUISVILLE
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State | KY
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Zip | 40243-2190
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Country | US
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Telephone | 313-204-4775
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST/OWNER
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Name | DR. JANEICE AISHA WOOTEN-KERR
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Credential | DDS
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Telephone | 313-204-4775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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