| South Shore Smiles Llc | |
|
9270 Wicker Ave Suite E And F Saint John IN 46373-8508 | |
| (219) 627-3133 | |
| Not Available |
| Full Name | South Shore Smiles Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9270 Wicker Ave, Saint John, Indiana |
| Authorized Official Name and Position | Roger K Shieh (OWNER) |
| Authorized Official Contact | 2197161259 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Shore Smiles Llc 9270 Wicker Ave Suite E And F Saint John IN 46373-8508 Ph: (219) 627-3133 | South Shore Smiles Llc 9270 Wicker Ave Suite E And F Saint John IN 46373-8508 Ph: (219) 627-3133 |
| NPI Number | 1356898050 |
|---|---|
| Provider Enumeration Date | 09/09/2016 |
| Last Update Date | 09/09/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356898050 | NPI | - | NPPES |
| 1144540980 | Medicaid | IN | |
| 1184944159 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 12011455A (Indiana) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | 12011456A (Indiana) | Secondary |
St John Smiles Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 9486 Wicker Ave, Saint John, IN 46373 Phone: 219-232-8956 | |
Mccarroll Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 10033 Wicker Ave Ste 9, Saint John, IN 46373 Phone: 219-365-9750 | |
Fontaine Dental Group Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 9301 Wicker Ave, Saint John, IN 46373 Phone: 219-365-7773 Fax: 219-365-8883 | |
Smile Solutions Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 8217 Wicker Ave, Saint John, IN 46373 Phone: 219-558-8326 |