Provider Demographics
NPI:1861500423
Name:SMILE CENTER P.C.
Entity Type:Organization
Organization Name:SMILE CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-683-2431
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-0143
Mailing Address - Country:US
Mailing Address - Phone:812-683-2431
Mailing Address - Fax:812-683-4603
Practice Address - Street 1:7120 S US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9319
Practice Address - Country:US
Practice Address - Phone:812-683-2431
Practice Address - Fax:812-683-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200449030AMedicaid
IN200130OtherCHILDREN'S SPECIAL HEALTH
IN612224OtherUNITED CONCORDIA