Healthcare Provider Details

I. General information

NPI: 1013812239
Provider Name (Legal Business Name): SPECIALIST SMILE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8342 LEMONT RD STE 3F
DARIEN IL
60561-1510
US

IV. Provider business mailing address

8342 LEMONT RD STE 3F
DARIEN IL
60561-1510
US

V. Phone/Fax

Practice location:
  • Phone: 630-581-0000
  • Fax: 331-200-5020
Mailing address:
  • Phone: 630-581-0000
  • Fax: 331-200-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROSA MENDEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 630-581-0000