MEDICARE: SMILE SOCIETY ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1003622168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE SOCIETY ORTHODONTICS

Provider Business Mailing Address
First Line	:	222 N COLUMBUS DR APT 3909
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7824
Country	:	US
Telephone Number	:	224-544-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 N MILWAUKEE AVE STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-9148
Country	:	US
Telephone Number	:	773-455-4776
Fax Number	:	312-547-1328

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. SAMIM LUKE TARAJI
Credential	:	DMD, MS
Telephone Number	:	224-544-0249

Provider Enumeration Date	:	12/04/2024
Last Update Date	:	08/26/2025

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