Provider Demographics
NPI:1427300797
Name:SMILE GENERATORS P.C.
Entity type:Organization
Organization Name:SMILE GENERATORS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-587-0100
Mailing Address - Street 1:4727 LISBORN DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-2201
Mailing Address - Country:US
Mailing Address - Phone:317-587-0100
Mailing Address - Fax:317-587-0200
Practice Address - Street 1:4727 LISBORN DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-2201
Practice Address - Country:US
Practice Address - Phone:317-587-0100
Practice Address - Fax:317-587-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. TODD W. WALTERS P.C,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008831A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100090710Medicaid