Provider Demographics
NPI:1386935203
Name:SPECIAL SMILES PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:SPECIAL SMILES PEDIATRIC DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SATTERFIELD-SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-873-3448
Mailing Address - Street 1:10801 N MICHIGAN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8170
Mailing Address - Country:US
Mailing Address - Phone:317-873-3448
Mailing Address - Fax:317-873-3425
Practice Address - Street 1:10801 N MICHIGAN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8170
Practice Address - Country:US
Practice Address - Phone:317-873-3448
Practice Address - Fax:317-873-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009492A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental