Healthcare Provider Details

I. General information

NPI: 1720356041
Provider Name (Legal Business Name): SMILES FOR LIFE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4479 CENTRAL AVE
WESTERN SPRINGS IL
60558-1714
US

IV. Provider business mailing address

4479 CENTRAL AVE
WESTERN SPRINGS IL
60558-1714
US

V. Phone/Fax

Practice location:
  • Phone: 708-579-5437
  • Fax: 708-550-4778
Mailing address:
  • Phone: 708-579-5437
  • Fax: 708-550-4778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number019.028214
License Number StateIL

VIII. Authorized Official

Name: DR. SUKHJIT KAUR
Title or Position: OWNER
Credential: DDS
Phone: 708-579-5437