MEDICARE: SHINY SMILES INC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1063785806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINY SMILES INC

Provider Business Mailing Address
First Line	:	3332 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6213
Country	:	US
Telephone Number	:	312-217-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	3332 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6213
Country	:	US
Telephone Number	:	312-217-2223
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MILAD NOURAHMADI
Credential	:	DDS
Telephone Number	:	312-217-2223

Provider Enumeration Date	:	02/09/2012
Last Update Date	:	10/15/2013

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Directions to “SHINY SMILES INC ” Practice Location

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