Provider Demographics
NPI:1609969567
Name:HEALTHY SMILES OF INDIANA, INC
Entity Type:Organization
Organization Name:HEALTHY SMILES OF INDIANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-897-3066
Mailing Address - Street 1:9020 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3025
Mailing Address - Country:US
Mailing Address - Phone:800-317-2434
Mailing Address - Fax:
Practice Address - Street 1:9020 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3025
Practice Address - Country:US
Practice Address - Phone:800-317-2434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN65000012A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty