Provider Demographics
NPI:1871061309
Name:GLOBAL SMILES DENTAL 5 LLC
Entity type:Organization
Organization Name:GLOBAL SMILES DENTAL 5 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-893-2700
Mailing Address - Street 1:7007 US 31 S STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-8591
Mailing Address - Country:US
Mailing Address - Phone:317-893-2700
Mailing Address - Fax:
Practice Address - Street 1:3410 N HIGH SCHOOL RD # BF
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-1742
Practice Address - Country:US
Practice Address - Phone:317-389-7751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty