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General NPI Number Information
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NPI Number | 1003622168
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Entity Type | Organization
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Legal Business Name | SMILE SOCIETY ORTHODONTICS
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 1328 N MILWAUKEE AVE STE 1
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City | CHICAGO
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State | IL
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Zip | 60622-9148
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Country | US
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Telephone | 773-455-4776
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Fax | 312-547-1328
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Provider Business Mailing Address
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Address Line | 222 N COLUMBUS DR APT 3909
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City | CHICAGO
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State | IL
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Zip | 60601-7824
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Country | US
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Telephone | 224-544-0249
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. SAMIM LUKE TARAJI
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Credential | DMD, MS
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Telephone | 224-544-0249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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