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General NPI Number Information
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NPI Number | 1972054286
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Entity Type | Organization
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Legal Business Name | SMILEBRITE LLC
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 401 WALL ST SUITE D
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City | VALPARAISO
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State | IN
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Zip | 46383-2521
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Country | US
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Telephone | 219-286-6228
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Fax | 219-286-6229
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Provider Business Mailing Address
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Address Line | 401 WALL ST SUITE D
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City | VALPARAISO
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State | IN
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Zip | 46383-2521
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Country | US
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Telephone | 219-286-6228
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Fax | 219-286-6229
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Authorized Official
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Title or Position | SOLE OWNER/PEDIATRIC DENTIST
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Name | DR. BERNADETTE ANNE DELUMPA FOLKE
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Credential | D.D.S., M.S.
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Telephone | 219-395-0403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12009505
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License Number State | IN
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