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General NPI Number Information
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NPI Number | 1821456591
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Entity Type | Organization
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Legal Business Name | SMILE CARE EXPERTS LLC
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 548 RIDGE RD STE A
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City | MUNSTER
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State | IN
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Zip | 46321-1600
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Country | US
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Telephone | 219-836-9122
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Fax | 219-836-9123
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Provider Business Mailing Address
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Address Line | 548 RIDGE RD STE A
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City | MUNSTER
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State | IN
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Zip | 46321-1600
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Country | US
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Telephone | 219-836-9122
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Fax | 219-836-9123
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Authorized Official
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Title or Position | OWNER/ DENTIST
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Name | DR. JEFFREY MILNE
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Credential | D.D.S.
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Telephone | 219-836-9122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12010293A
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License Number State | IN
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