| Gary Smiles Youth Dentistry, Llc | |
|
3506 Village Ct Gary IN 46408-1428 | |
| (219) 985-3133 | |
| (219) 985-3139 |
| Full Name | Gary Smiles Youth Dentistry, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3506 Village Ct, Gary, Indiana |
| Authorized Official Name and Position | Jenell Stump (MANAGER, LICENSING & CREDENTIALING) |
| Authorized Official Contact | 6157500343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary Smiles Youth Dentistry, Llc 16 Arcade Unit 198747 Nashville TN 37219-1994 Ph: (615) 750-0343 | Gary Smiles Youth Dentistry, Llc 3506 Village Ct Gary IN 46408-1428 Ph: (219) 985-3133 |
| NPI Number | 1073684247 |
|---|---|
| Provider Enumeration Date | 11/10/2006 |
| Last Update Date | 07/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073684247 | NPI | - | NPPES |
| 1073684247 | Medicaid | IL | |
| 200379630A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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