Healthcare Provider Details

I. General information

NPI: 1497239917
Provider Name (Legal Business Name): SMILE ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S BARTLETT RD STE 105
STREAMWOOD IL
60107-2407
US

IV. Provider business mailing address

820 S BARTLETT RD STE 105
STREAMWOOD IL
60107-2407
US

V. Phone/Fax

Practice location:
  • Phone: 630-830-9700
  • Fax: 630-830-9739
Mailing address:
  • Phone: 630-830-9700
  • Fax: 630-830-9739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: PRANAV PATEL
Title or Position: MBR
Credential: DDS
Phone: 630-452-3810