Provider Demographics
NPI:1952919847
Name:SMILE CONCEPTS LLC
Entity Type:Organization
Organization Name:SMILE CONCEPTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ JORDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-319-0108
Mailing Address - Street 1:8455 W 101ST PL
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-7703
Mailing Address - Country:US
Mailing Address - Phone:786-838-3683
Mailing Address - Fax:
Practice Address - Street 1:1519 US HIGHWAY 41 STE B8
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1373
Practice Address - Country:US
Practice Address - Phone:219-319-0108
Practice Address - Fax:219-440-7438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental