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General NPI Number Information
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NPI Number | 1609342393
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Entity Type | Organization
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Legal Business Name | CHICAGO SMILES, LLC
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 227 W MONROE ST STE 205
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City | CHICAGO
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State | IL
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Zip | 60606-5017
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Country | US
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Telephone | 312-346-0171
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Fax |
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Provider Business Mailing Address
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Address Line | 227 W MONROE ST STE 205
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City | CHICAGO
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State | IL
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Zip | 60606-5017
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. MARK A SANTUCCI
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Credential | DDS
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Telephone | 312-810-3200
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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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