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General NPI Number Information
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NPI Number | 1518456557
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Entity Type | Organization
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Legal Business Name | SMILE DOCTORS OF INDIANA, P.C.
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 1410 S QUAIL RUN RD
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City | VINCENNES
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State | IN
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Zip | 47591-6845
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Country | US
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Telephone | 812-882-7867
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 S QUAIL RUN RD
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City | VINCENNES
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State | IN
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Zip | 47591-6845
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Country | US
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Telephone | 812-882-7867
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANA E FENDER
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Credential | DMD
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Telephone | 812-882-7867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12012617A
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License Number State | IN
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