Create-A-Smile, PC
NPI 1588995229ActiveOrganization· Dentist· Bloomington, IN
Dentist in Bloomington, Indiana, registered in NPPES in January 2010. The authorized official on file is Shannon Kenneth Moore, DMD, MSED, Owner.
Overview
| NPI | 1588995229 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 20, 2010 |
| Last updated in NPPES | May 17, 2022 |
| Certified by provider | May 17, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | 12010311A | IN |
| Dentist | 122300000X | 12011246A | IN |
| Durable Medical Equipment & Medical Supplies | 332B00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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