Provider Demographics
NPI:1881812097
Name:SMITH-BRAUER DENTISTRY
Entity type:Organization
Organization Name:SMITH-BRAUER DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-585-0005
Mailing Address - Street 1:5625 CASTLE CREEK PARKWAY N. DRIVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4304
Mailing Address - Country:US
Mailing Address - Phone:317-585-0005
Mailing Address - Fax:
Practice Address - Street 1:5625 CASTLE CREEK PARKWAY N. DRIVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4304
Practice Address - Country:US
Practice Address - Phone:317-585-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010538A122300000X
IN12006427A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty