South Shore Smiles Llc
LBN: South Shore Smiles Llc
South Shore Smiles Llc is an health care organization with primary practice located at 9270 Wicker Ave Suite E And F, Saint John IN 46373-8508. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry. Dental Providers / General Practice is the primary health care specialty.
South Shore Smiles Llc can be contacted via phone (219) 627-3133, or through Shieh, Roger K via phone (219) 716-1259.
Contact Information
Primary practice address
9270 Wicker Ave Suite E And F
Saint John IN 46373-8508
Phone: (219) 627-3133
Fax:
Website:
Authorized official contact:
Name: Shieh, Roger K Doctor of Dental Surgery (DDS)
Phone: (219) 716-1259
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 12011455A | Indiana |
| Dental Providers / Pediatric Dentistry | 1223P0221X | 12011456A | Indiana |
Profile Details
| NPI number | 1356898050 |
|---|---|
| LBN Legal business name | South Shore Smiles Llc |
| DBA Doing business as | |
| Authorized official | Shieh, Roger K Doctor of Dental Surgery (DDS) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 9th, 2016 |
| Last updated | Sep 9th, 2016 - about 10 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1356898050 | NPPES |
| Indiana | MEDICAID | 1144540980 | |
| Indiana | MEDICAID | 1184944159 |
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