Provider Demographics
NPI:1770358699
Name:SMILEVIBE DENTAL
Entity type:Organization
Organization Name:SMILEVIBE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOUDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:459-328-9536
Mailing Address - Street 1:5922 GARDEN GATE WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8251
Mailing Address - Country:US
Mailing Address - Phone:469-328-9536
Mailing Address - Fax:
Practice Address - Street 1:1375 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1954
Practice Address - Country:US
Practice Address - Phone:317-873-8902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty