SOUTH BEND SMILES YOUTH DENTISTRY, LLC
NPI 1902017593
Dentist - General Practice in Mishawaka, IN

Q: What is South Bend Smiles Youth Dentistry, LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Active since May 24, 2007

2332 MIRACLE LN, MISHAWAKA, IN 46545(574) 259-5437(574) 259-5438 Get Directions Write a Review

NPPES record last updated: July 9, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About South Bend Smiles Youth Dentistry, Llc NPPES

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

SOUTH BEND SMILES YOUTH DENTISTRY, LLC (NPI 1902017593) is a healthcare organization registered as a general practice in Mishawaka, Indiana and active in the NPI registry since May 2007. The organization lists Jenell Stump, Manager, Licensing & Credentialing, as its authorized official.

NPPES Registry Identity

NPI1902017593

Entity TypeOrganization

Primary Taxonomy1223G0001X

Legal Business NameSOUTH BEND SMILES YOUTH DENTISTRY, LLC

Location Address2332 MIRACLE LNMishawaka, IN 46545-3012

Mailing Address16 Arcade Unit 198747Nashville, TN 37219-1994 · (615) 750-0343 · Fax (615) 986-1705

Phone(574) 259-5437

Fax(574) 259-5438

Organization SubpartNo

Authorized OfficialJenell StumpManager, Licensing & Credentialing · (615) 750-0343

Enumeration DateMay 24, 2007

Last NPPES UpdateJuly 9, 2014

✔ NPI 1902017593 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

2332 MIRACLE LN, Mishawaka, IN 46545

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Other Identifiers 2

Medicaid1902017593MI

Medicaid200828710AIN

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 SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CLAUDETTE UMURERWA MUNYABERA DDS

Dentist (Pediatric Dentistry)

2332 MIRACLE LN
MISHAWAKA, IN 46545

St. Joseph County (574) 259-5437

MIRACLE LANE FAMILY DENTISTRY P.C.

Clinic/Center (Dental)

2332 MIRACLE LN
MISHAWAKA, IN 46545

St. Joseph County (574) 259-5437

REKHA RETHIYAMMA DMD

Dentist (General Practice)

2332 MIRACLE LN
MISHAWAKA, IN 46545

St. Joseph County (574) 259-5437

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 South Bend Smiles Youth Dentistry, LLC's NPI number?

The NPI number for South Bend Smiles Youth Dentistry, LLC is 1902017593. It was assigned to this organization in the NPPES registry on May 24, 2007.

Where is South Bend Smiles Youth Dentistry, LLC located?

South Bend Smiles Youth Dentistry, LLC is located at 2332 Miracle Ln, Mishawaka, IN 46545. The listed phone number is (574) 259-5437.

What is South Bend Smiles Youth Dentistry, LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for South Bend Smiles Youth Dentistry, LLC was last updated on July 9, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.