Provider Demographics
NPI:1528483021
Name:CREATING SMILES PC
Entity type:Organization
Organization Name:CREATING SMILES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAPERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-322-9920
Mailing Address - Street 1:8217 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373
Mailing Address - Country:US
Mailing Address - Phone:219-322-9920
Mailing Address - Fax:219-322-2039
Practice Address - Street 1:8217 WICKER AVE
Practice Address - Street 2:
Practice Address - City:ST JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373
Practice Address - Country:US
Practice Address - Phone:219-322-9920
Practice Address - Fax:219-322-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011967A1223G0001X
IN120095701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100148080Medicaid