MEDICARE: LINCOLN SMILES FAMILY DENTISTRY

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1306557483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOLN SMILES FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	5643 N FAIRFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4816
Country	:	US
Telephone Number	:	773-271-5600
Fax Number	:	773-271-3280

Provider Business Practice Location Address
First Line	:	5643 N FAIRFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4816
Country	:	US
Telephone Number	:	773-271-5600
Fax Number	:	773-271-3280

Authorized Official
Title or Position	:	OWNER
Name	:	ODILIA L NAVARRETE
Credential	:	DDS
Telephone Number	:	773-271-5200

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	12/08/2022

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