Provider Demographics
NPI:1508287046
Name:FRIENDLY SMILES FAMILY DENTISTRY
Entity Type:Organization
Organization Name:FRIENDLY SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LORRE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MISHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-232-5904
Mailing Address - Street 1:1461 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-1251
Mailing Address - Country:US
Mailing Address - Phone:812-232-5904
Mailing Address - Fax:812-234-1430
Practice Address - Street 1:1461 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-1251
Practice Address - Country:US
Practice Address - Phone:812-232-5904
Practice Address - Fax:812-234-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009589B261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental