Provider Demographics
NPI:1902542160
Name:SWEET TOOTH DENTISTRY, LLC
Entity Type:Organization
Organization Name:SWEET TOOTH DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEREEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELSAHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-910-7832
Mailing Address - Street 1:9510 N MERIDIAN ST STE 250
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1334
Mailing Address - Country:US
Mailing Address - Phone:317-910-7832
Mailing Address - Fax:
Practice Address - Street 1:9510 N MERIDIAN ST STE 250
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1334
Practice Address - Country:US
Practice Address - Phone:317-910-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12012010AOtherIN DENTAL LICENSE
IN201249040Medicaid
IN1851731483OtherNPI TYPE 1