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General NPI Number Information
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NPI Number | 1235096074
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Entity Type | Organization
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Legal Business Name | DIVINE SMILES, PLLC
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 990 GRAND CANYON PKWY STE 215
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-1735
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Country | US
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Telephone | 989-977-1771
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Fax |
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Provider Business Mailing Address
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Address Line | 4609 AMY DR
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6362
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Country | US
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Telephone | 989-977-1771
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VIBHA BABBAR SHANKARA
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Credential | DMD
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Telephone | 989-977-1771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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