Create-a-smile, Pc is a Dental Clinic in Bloomington, Indiana. It is located at 2815 N Walnut St, Bloomington, IN and its contact number is 812-332-1405. The authorized person for Create-a-smile, Pc is Dr. Shannon Kenneth Moore
who is Owner of the clinic and their contact number is 812-332-1405. The primary license number for Create-a-smile, Pc is 12010311A (Dentist) in Indiana. Create-a-smile, Pc Clinic have dental surgeons who are specialized in dentistry, diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aids in providing oral health services. The dental team includes dental assistants, dental hygienists, dental technicians, and sometimes dental therapists.
Complete Clinic Profile:
Create-a-smile, Pc Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
Name:
Create-a-smile, Pc
Specialization:
Dentistry
Clinic Address:
2815 N Walnut St, Bloomington, Indiana, 47404-2077
Phone:
812-332-1405
Fax:
812-332-4331
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints for this clinic are as below. Person's position and contact details are also mentioned below.
Name:
Dr. Shannon Kenneth Moore
Position:
Owner
Contact Number:
812-332-1405
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for Create-a-smile, Pc clinic are as mentioned below.
NPI Number:
1588995229
NPI Enumeration Date:
20 Jan, 2010
NPI Last Update On:
17 May, 2022
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Create-a-smile, Pc are as mentioned below.
Specialization
License Number
State
Status
Dentist
12010311A
Indiana
Primary
Dentist
12011246A
Indiana
Secondary
Durable Medical Equipment & Medical Supplies
Secondary
Other Medical Identifiers:
Other legacy medical identifiers of the clinic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
Identifier
Type
State
Issuer
200326230
Medicaid
Indiana
1194855205
Other
Indiana
Npi
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
Create-a-smile, Pc 2815 N Walnut St, Bloomington, Indiana
Zip:
47404-2077
Phone Number:
812-332-1405
Fax Number:
812-332-4331
Patients can reach Create-a-smile, Pc at 2815 N Walnut St, Bloomington, Indiana or can call to book an appointment on 812-332-1405. Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 11 March, 2024.