CREATE-A-SMILE, PC
NPI 1588995229
Dentist in Bloomington, IN

Q: What is Create-A-Smile, PC's NPI number?

The NPI number for Create-A-Smile, PC is 1588995229. It was assigned to this organization in the NPPES registry on January 20, 2010.

Q: What is Create-A-Smile, PC's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Active since January 20, 2010

2815 N WALNUT ST, BLOOMINGTON, IN 47404(812) 332-1405(812) 332-4331 Get Directions Write a Review

NPPES record last updated: May 17, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 17, 2022, Jan 19, 2022, Feb 16, 2017 (3 updates tracked since 2017).

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About Create-a-smile, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CREATE-A-SMILE, PC (NPI 1588995229) is a healthcare organization registered as a dentist in Bloomington, Indiana and active in the NPI registry since January 2010. The organization lists Shannon Kenneth Moore, Owner, as its authorized official.

NPPES Registry Identity

NPI1588995229

Entity TypeOrganization

Primary Taxonomy122300000X

Legal Business NameCREATE-A-SMILE, PC

Location Address2815 N WALNUT STBloomington, IN 47404-2077

Mailing Address2815 N Walnut StBloomington, IN 47404-2077 · (812) 332-1405 · Fax (812) 332-4331

Phone(812) 332-1405

Fax(812) 332-4331

Organization SubpartNo

Authorized OfficialShannon Kenneth MooreOwner · (812) 332-1405

Enumeration DateJanuary 20, 2010

Last NPPES UpdateMay 17, 20223 updates tracked since enumeration

NPPES CertifiedMay 17, 2022

✔ NPI 1588995229 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

Licenses✔ Licensed in IN · 12010311A✔ Licensed in IN · 12011246A

Definition

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.

Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X

2815 N WALNUT ST, Bloomington, IN 47404

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Other Identifiers 2

Other1194855205IN · Npi

Medicaid200326230IN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Create-A-Smile, PC's NPI number?

The NPI number for Create-A-Smile, PC is 1588995229. It was assigned to this organization in the NPPES registry on January 20, 2010.

Where is Create-A-Smile, PC located?

Create-A-Smile, PC is located at 2815 N Walnut St, Bloomington, IN 47404. The listed phone number is (812) 332-1405.

What is Create-A-Smile, PC's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

When was this NPI record last updated?

The NPPES record for Create-A-Smile, PC was last updated on May 17, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.