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General NPI Number Information
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NPI Number | 1396235651
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Entity Type | Organization
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Legal Business Name | LOVE MY SMILE CHICAGO, LLC
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Dates
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Enumeration Date | 05/12/2018
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Last Update Date | 01/13/2019
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Provider Practice Location Address
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Address Line | 2112 N CLYBOURN AVE UNIT B
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City | CHICAGO
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State | IL
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Zip | 60614-0800
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Country | US
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Telephone | 858-699-6741
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Fax |
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Provider Business Mailing Address
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Address Line | 2112 N CLYBOURN AVE UNIT B
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City | CHICAGO
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State | IL
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Zip | 60614-0800
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Country | US
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Telephone | 773-382-1771
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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. KATHARINE STEVENS
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Credential | DDS, MS
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Telephone | 773-382-1771
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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 | 021002679
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License Number State | IL
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