| Summit City Smiles | |
|
1330 E State Blvd Fort Wayne IN 46805-4422 | |
| (260) 484-5614 | |
| Not Available |
| Full Name | Summit City Smiles |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1330 E State Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Roger Paul Valliere (PRESIDENT) |
| Authorized Official Contact | 2604845614 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit City Smiles 1330 E State Blvd Fort Wayne IN 46805-4422 Ph: (260) 484-5614 | Summit City Smiles 1330 E State Blvd Fort Wayne IN 46805-4422 Ph: (260) 484-5614 |
| NPI Number | 1083080386 |
|---|---|
| Provider Enumeration Date | 08/20/2015 |
| Last Update Date | 08/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083080386 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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