| South Bend Smiles Youth Dentistry, Llc | |
|
2332 Miracle Ln Mishawaka IN 46545-3012 | |
| (574) 259-5437 | |
| (574) 259-5438 |
| Full Name | South Bend Smiles Youth Dentistry, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2332 Miracle Ln, Mishawaka, 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 |
|---|---|
| South Bend Smiles Youth Dentistry, Llc 16 Arcade Unit 198747 Nashville TN 37219-1994 Ph: (615) 750-0343 | South Bend Smiles Youth Dentistry, Llc 2332 Miracle Ln Mishawaka IN 46545-3012 Ph: (574) 259-5437 |
| NPI Number | 1902017593 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 07/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902017593 | NPI | - | NPPES |
| 200828710A | Medicaid | IN | |
| 1902017593 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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