Provider Demographics
NPI:1346812187
Name:NOBLESVILLE SMILE CENTER, LLC
Entity Type:Organization
Organization Name:NOBLESVILLE SMILE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DHANJAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-417-8254
Mailing Address - Street 1:17147 MERCANTILE BLVD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-3942
Mailing Address - Country:US
Mailing Address - Phone:317-558-9500
Mailing Address - Fax:317-558-9501
Practice Address - Street 1:17147 MERCANTILE BLVD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3942
Practice Address - Country:US
Practice Address - Phone:317-558-9500
Practice Address - Fax:317-558-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12013135AOtherIN DENTAL LICENSE
IN1164911855OtherNPI TYPE 1
IN300030245Medicaid