Provider Demographics
NPI:1356086276
Name:SERENITY SMILE CARE, LLC
Entity Type:Organization
Organization Name:SERENITY SMILE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANEICE
Authorized Official - Middle Name:AISHA
Authorized Official - Last Name:WOOTEN-KERR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-204-4775
Mailing Address - Street 1:11902 MEMORY RUN PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2190
Mailing Address - Country:US
Mailing Address - Phone:313-204-4775
Mailing Address - Fax:
Practice Address - Street 1:322 N. INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172
Practice Address - Country:US
Practice Address - Phone:313-204-4775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental