MEDICARE: SMILECHICAGO

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	1223G0001X	General Practice Dentistry	1916429	IL

General Provider Information

NPI Number	:	1568537223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILECHICAGO

Provider Business Mailing Address
First Line	:	400 N MICHIGAN AVE
Second Line	:	SUITE 1014
City	:	CHICAGO
State	:	IL
Zip	:	60611-4104
Country	:	US
Telephone Number	:	312-644-4321
Fax Number	:	312-644-4325

Provider Business Practice Location Address
First Line	:	400 N MICHIGAN AVE
Second Line	:	SUITE 1014
City	:	CHICAGO
State	:	IL
Zip	:	60611-4104
Country	:	US
Telephone Number	:	312-644-4321
Fax Number	:	312-644-4325

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHELDON SEIDMAN
Credential	:	DDS
Telephone Number	:	312-644-4321

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/22/2020

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Directions to “SMILECHICAGO ” Practice Location

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