CREATE-A-SMILE PC (NPI# 1588995229) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588995229 |
| Entity Type | Organization |
| Organization Name | CREATE-A-SMILE PC |
| Practice Address |
219 E. 17th St. Bloomington IN 47408 |
| Mailing Address |
219 E 17th St Bloomington IN 47408-1731 |
| Practice Telephone | 8123321405 |
| Practice Fax Number | 8123324331 |
| Mailing Telephone | 8123321405 |
| Mailing Fax Number | 8123324331 |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2017-02-16 |
| Authorized Official Name | DR. SHANNON KENNETH MOORE (OWNER) |
| Authorized Official Telephone | 8123321405 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 12011246A | IN | Dental Providers |
| Y | 122300000X | Dentist | 12010311A | IN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200326230 | 05 |
| Street Address |
219 E. 17TH ST. |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47408 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669079398 | Ta-kisha Jones | Health Educator | 309 N. Woodlawn Ave, Bloomington, IN 47408 | 2020-10-06 |
| 1265915904 | Meghan Elizabeth Kinkead | Specialist/Technologist | Simon Skjodt Assembly Hall, 1001 East 17th Street, Bloomington, IN 47408 | 2018-09-10 |
| 1316499395 | Marabai Rose Counseling, LLC | Social Worker | 4568 East State Rd 45, Bloomington, IN 47408 | 2016-10-26 |
| 1295133908 | Eden Embree | Specialist/Technologist | 1001 E. 17th Street, Assembly Hall, Bloomington, IN 47408 | 2014-12-11 |
| 1609053289 | Laurette Frazier | Counselor | 2815 E. 10th Street, Stone Belt, Bloomington, IN 47408 | 2008-01-26 |
| 1770709917 | Robin A. Roberts | Dentist | 104 E. 19th Street, Bloomington, IN 47408 | 2007-04-17 |
| 1376614008 | David Rudolf Fletcher | General Practice | 126 S. Hampton Ct, Bloomington, IN 47408 | 2006-11-13 |
| 1114013752 | Christole, Inc | Intermediate Care Facility, Mentally Retarded | 2727 N Dunn, Bloomington, IN 47408 | 2006-10-04 |
| 1003850322 | Priti V Jindal | Internal Medicine | 2455 N Tamarack Trl, Bloomington, IN 47408 | 2006-06-16 |
| 1306830849 | John William Schrader | Specialist/Technologist | 1001 E. 17th Street, Assembly Hall, Sports Medicine Department, Bloomington, IN 47408 | 2005-09-09 |
| Find all providers in zip 47408 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962026948 | Maria Contreras Mantilla | Dentist | 1320 W Bloomfield Rd, Bloomington, IN 47403-2001 | 2020-06-04 |
| 1144703026 | Aneetam Bassi | Dentist | 3609 General Electric Rd Ste A, Bloomington, IL 61704-8766 | 2018-09-07 |
| 1467934505 | Mary Therese Block | Dentist | 2507 E Poplar Dr, Bloomington, IN 47401-4327 | 2018-09-05 |
| 1619456373 | Applewhite Dental Illinois, P.C. | Dentist | 2103 E Washington St Ste 1c, Bloomington, IL 61701-4365 | 2018-08-13 |
| 1154842581 | Anna Noel Nord | Dentist | 1404 Eastland Dr Ste 102, Bloomington, IL 61701-7904 | 2017-07-06 |
| 1528416302 | Nathaniel Gonzales | Dentist | 10700 France Ave S Ste 102, Bloomington, MN 55431-3693 | 2016-06-02 |
| 1902251911 | Optim Dental Bloomington LLC | Dentist | 401 N Veterans Pkwy Ste 4, Bloomington, IL 61704-7716 | 2016-04-27 |
| 1194181560 | Sleep Solutions of Central Illinois | Dentist | 2309 E. Empire St, Suite 500, Bloomington, IL 61704-8900 | 2016-01-14 |
| 1619353521 | Courtney Morgan | Dentist | 2306 Stern Dr, Bloomington, IL 61704-4406 | 2015-08-03 |
| 1508240763 | Marisa Lee Milligan | Dentist | 1404 Eastland Dr Ste 101, Bloomington, IL 61701-7904 | 2015-07-16 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 47408 |
Please comment or provide details below to improve the information on CREATE-A-SMILE PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.