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General NPI Number Information
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NPI Number | 1750754792
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Entity Type | Organization
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Legal Business Name | SMILE CENTRAL
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 7131 N RIDGE BLVD
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City | CHICAGO
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State | IL
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Zip | 60645-3616
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Country | US
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Telephone | 773-764-7575
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Fax | 773-764-2951
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Provider Business Mailing Address
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Address Line | 7131 N RIDGE BLVD
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City | CHICAGO
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State | IL
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Zip | 60645-3616
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Country | US
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Telephone | 773-764-7575
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Fax | 773-764-2951
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY CHIPP
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Credential | D.D.S.
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Telephone | 773-764-7575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019022787
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License Number State | IL
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