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General NPI Number Information
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NPI Number | 1780345710
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Entity Type | Organization
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Legal Business Name | NORTH SHORE SMILE STUDIO LLC
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 845 N MICHIGAN AVE STE 951W
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City | CHICAGO
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State | IL
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Zip | 60611-2211
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Country | US
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Telephone | 312-787-2131
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Fax |
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Provider Business Mailing Address
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Address Line | 845 N MICHIGAN AVE STE 951W
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City | CHICAGO
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State | IL
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Zip | 60611-2211
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Country | US
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Telephone | 312-787-2131
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. DANIEL ANESZKO
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Credential | DDS
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Telephone | 312-787-2131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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