Healthcare Provider Details

I. General information

NPI: 1659290724
Provider Name (Legal Business Name): YASHVIRSMILE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E EVERGREEN AVE STE 124
MOUNT PROSPECT IL
60056-3240
US

IV. Provider business mailing address

3227 RONALD RD
GLENVIEW IL
60025-4562
US

V. Phone/Fax

Practice location:
  • Phone: 847-253-8350
  • Fax: 847-253-8630
Mailing address:
  • Phone: 847-505-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAGRUTI DUDHATRA
Title or Position: OWNER
Credential:
Phone: 847-505-5773