Provider Demographics
NPI:1942606959
Name:SUPERB SMILES DENTAL CARE LLC
Entity Type:Organization
Organization Name:SUPERB SMILES DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:WINTERS
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-932-5533
Mailing Address - Street 1:200 CONRAD HARCOURT WAY
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1100
Mailing Address - Country:US
Mailing Address - Phone:765-932-5533
Mailing Address - Fax:765-932-4569
Practice Address - Street 1:200 CONRAD HARCOURT WAY
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1100
Practice Address - Country:US
Practice Address - Phone:765-932-5533
Practice Address - Fax:765-932-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011447A122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty