Healthcare Provider Details

I. General information

NPI: 1487921102
Provider Name (Legal Business Name): SMILE DESIGN STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 N ROSELLE RD
HOFFMAN ESTATES IL
60169-1850
US

IV. Provider business mailing address

890 N ROSELLE RD
HOFFMAN ESTATE IL
60169
US

V. Phone/Fax

Practice location:
  • Phone: 847-885-7645
  • Fax: 847-885-7646
Mailing address:
  • Phone: 847-885-7645
  • Fax: 847-885-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number019026764
License Number StateIL

VIII. Authorized Official

Name: DR. PIOTR TROYAN
Title or Position: OWNER
Credential: D.M.D.
Phone: 847-885-7645