Healthcare Provider Details

I. General information

NPI: 1548889496
Provider Name (Legal Business Name): KTSMILES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 MAIN ST
EVANSTON IL
60202-1548
US

IV. Provider business mailing address

2422 MAIN ST
EVANSTON IL
60202-1548
US

V. Phone/Fax

Practice location:
  • Phone: 847-264-9330
  • Fax: 618-217-5367
Mailing address:
  • Phone: 847-264-9330
  • Fax: 618-217-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY SMITH
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 847-833-1272