MEDICARE: KIMBERLY SMILES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223G0001X	General Practice Dentistry
3	1223P0221X	Pediatric Dentistry
4	1223P0300X	Periodontics
5	1223P0700X	Prosthodontics
6	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
7	124Q00000X	Dental Hygienist
8	126800000X	Dental Assistant
9	122300000X	Dentist

General Provider Information

NPI Number	:	1780020461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY SMILES

Provider Business Mailing Address
First Line	:	1835 N MILWAUKEE AVE
Second Line	:	CW
City	:	CHICAGO
State	:	IL
Zip	:	60647-6186
Country	:	US
Telephone Number	:	773-276-1047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 N MILWAUKEE AVE
Second Line	:	CW
City	:	CHICAGO
State	:	IL
Zip	:	60647-6186
Country	:	US
Telephone Number	:	773-276-1047
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. PAUL ANAST
Credential	:	D.M.D.
Telephone Number	:	773-276-1047

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	05/21/2013

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Directions to “KIMBERLY SMILES ” Practice Location

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