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General NPI Number Information
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NPI Number | 1528231404
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Entity Type | Organization
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Legal Business Name | YOUR SMILE BY DESIGN, P.C.
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 3939 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60647-2243
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Country | US
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Telephone | 773-235-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 W BELMONT AVE UNIT 708
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City | CHICAGO
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State | IL
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Zip | 60657-3047
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Country | US
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Telephone | 773-327-6692
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID INGALLINERA
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Credential | D.D.S.
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Telephone | 773-327-6692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 019025292
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License Number State | IL
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