Provider Demographics
NPI:1598910598
Name:BETWEEN THE CHEEKS, PC
Entity Type:Organization
Organization Name:BETWEEN THE CHEEKS, PC
Other - Org Name:SMILE DESIGN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:317-293-4611
Mailing Address - Street 1:5470 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1620
Mailing Address - Country:US
Mailing Address - Phone:317-293-4611
Mailing Address - Fax:317-297-7504
Practice Address - Street 1:5470 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1620
Practice Address - Country:US
Practice Address - Phone:317-293-4611
Practice Address - Fax:317-297-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010288A122300000X
IN26019790A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty