Provider Demographics
NPI:1316128655
Name:PEARLY WHITE SMILES
Entity type:Organization
Organization Name:PEARLY WHITE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-849-3444
Mailing Address - Street 1:9126 TECHNOLOGY LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3064
Mailing Address - Country:US
Mailing Address - Phone:317-849-3444
Mailing Address - Fax:317-849-2555
Practice Address - Street 1:9126 TECHNOLOGY LN
Practice Address - Street 2:SUITE 200
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3064
Practice Address - Country:US
Practice Address - Phone:317-849-3444
Practice Address - Fax:317-849-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1200761A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty