Provider Demographics
NPI:1376141168
Name:LODS OF SMILES FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:LODS OF SMILES FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:LODS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-703-6689
Mailing Address - Street 1:5101 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-6300
Mailing Address - Country:US
Mailing Address - Phone:740-703-6689
Mailing Address - Fax:
Practice Address - Street 1:110 E YORK ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-1732
Practice Address - Country:US
Practice Address - Phone:740-703-6689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1326568494OtherNPI