| Prime Smile West | |
|
2802 Lafayette Road Suite 33 Indianapolis IN 46222 | |
| (317) 925-2810 | |
| Not Available |
| Full Name | Prime Smile West |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2802 Lafayette Road, Indianapolis, Indiana |
| Authorized Official Name and Position | Helen K. Peterson (OWNER) |
| Authorized Official Contact | 3179252810 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Smile West 2802 Lafayette Road Suite 33 Indianapolis IN 46222 Ph: (317) 925-2810 | Prime Smile West 2802 Lafayette Road Suite 33 Indianapolis IN 46222 Ph: (317) 925-2810 |
| NPI Number | 1134164445 |
|---|---|
| Provider Enumeration Date | 06/19/2006 |
| Last Update Date | 07/01/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134164445 | NPI | - | NPPES |
| 200434530A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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