South Shore Smiles LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12011455A Issued in IN

Legal business name

SOUTH SHORE SMILES LLC

Practice address

9270 Wicker Ave
Suite E and F
Saint John, IN 46373-8508

Phone

(219) 627-3133

NPI assigned

Sep 9, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Roger K Shieh, DDS

Title

Owner

Phone

(219) 716-1259

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473379200000",
    "number": "1356898050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9270 WICKER AVE",
            "address_2": "SUITE E AND F",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463738508",
            "telephone_number": "219-627-3133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9270 WICKER AVE",
            "address_2": "SUITE E AND F",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463738508",
            "telephone_number": "219-627-3133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE SMILES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-09",
        "last_updated": "2016-09-09",
        "status": "A",
        "authorized_official_last_name": "SHIEH",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-716-1259",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011455A",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12011456A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144540980",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184944159",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sencare LLC
• Saaduddin Mohammed Siddiqui, MD
• Smile Solutions Inc
• Latrese Smith-Wynn, PT, DPT
• Kyerra Smith, MA, BCBA
• St George Rehabilitation Services LLC
• St John Smiles PC
• St Margaret Mercy Healthcare Centers
• St Mena Therapy P.C.
• St. John Premier Dental

• General Practice Dentistry in Saint John, IN
• Providers in Saint John, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.