Gary Smiles Youth Dentistry, LLC

NPI #1073684247 in Gary, Indiana

Provider Information

NPI Number: 1073684247
Entity Type: Organization
Organization Name: Gary Smiles Youth Dentistry, LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 10, 2006
Last Updated: Jul 9, 2014

Practice Location

Address: 3506 VILLAGE CT
City: Gary
State: Indiana
ZIP Code: 46408-1428
Phone: (219) 985-3133

Authorized Official

Name: MRS. JENELL STUMP
Title: MANAGER, LICENSING & CREDENTIALING
Phone: (615) 750-0343

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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