Provider Demographics
NPI:1689837940
Name:RLI DENTAL, LLC
Entity Type:Organization
Organization Name:RLI DENTAL, LLC
Other - Org Name:SIMPLY SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:NEMSER
Authorized Official - Suffix:
Authorized Official - Credentials:LDH
Authorized Official - Phone:317-570-5480
Mailing Address - Street 1:7340 CROSSING PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2785
Mailing Address - Country:US
Mailing Address - Phone:317-570-5480
Mailing Address - Fax:317-570-5481
Practice Address - Street 1:7340 CROSSING PL
Practice Address - Street 2:SUITE 200
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2785
Practice Address - Country:US
Practice Address - Phone:317-570-5480
Practice Address - Fax:317-570-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010486A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200402720AMedicaid