MEDICARE: SMILES OF ARLINGTON HEIGHTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1548947948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILES OF ARLINGTON HEIGHTS

Provider Business Mailing Address
First Line	:	483 EVERGREEN DR
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-2907
Country	:	US
Telephone Number	:	330-338-7080
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 S VAIL AVE STE 105
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1879
Country	:	US
Telephone Number	:	847-253-4626
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PRIYADARSHINI BOINPALLY
Credential	:	DDS
Telephone Number	:	330-338-7080

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	06/28/2023

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