Provider Demographics
NPI:1295828135
Name:A NEW SMILE, P.C.
Entity Type:Organization
Organization Name:A NEW SMILE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:NEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-888-6684
Mailing Address - Street 1:1700 W SMITH VALLEY RD STE C2
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1589
Mailing Address - Country:US
Mailing Address - Phone:317-888-6684
Mailing Address - Fax:317-888-6687
Practice Address - Street 1:1700 W SMITH VALLEY RD STE C2
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1589
Practice Address - Country:US
Practice Address - Phone:317-888-6684
Practice Address - Fax:317-888-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010449 A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1744673OtherUNITED CONCORDIA ID #
IN200532750 AMedicaid