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General NPI Number Information
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NPI Number | 1427300797
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Entity Type | Organization
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Legal Business Name | SMILE GENERATORS P.C.
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 4727 LISBORN DR
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City | CARMEL
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State | IN
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Zip | 46033-2201
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Country | US
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Telephone | 317-587-0100
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Fax | 317-587-0200
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Provider Business Mailing Address
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Address Line | 4727 LISBORN DR
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City | CARMEL
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State | IN
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Zip | 46033-2201
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Country | US
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Telephone | 317-587-0100
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Fax | 317-587-0200
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. TODD WALTERS
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Credential | D.D.S.
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Telephone | 317-587-0100
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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 | 12008831A
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License Number State | IN
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