| Prime Smile East | |
|
5430 East Washington Street Suite 101 Indianapolis IN 46219 | |
| (317) 322-1840 | |
| (615) 986-1705 |
| Full Name | Prime Smile East |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5430 East Washington Street, Indianapolis, Indiana |
| Authorized Official Name and Position | Helen K. Peterson (OWNER) |
| Authorized Official Contact | 3173221840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Smile East 5430 East Washington Street Suite 101 Indianapolis IN 46219 Ph: (317) 322-1840 | Prime Smile East 5430 East Washington Street Suite 101 Indianapolis IN 46219 Ph: (317) 322-1840 |
| NPI Number | 1013952696 |
|---|---|
| Provider Enumeration Date | 06/18/2006 |
| Last Update Date | 06/24/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013952696 | NPI | - | NPPES |
| 200361860A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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