MEDICARE: NEW SMILE CENTER

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	122300000X	Dentist	019-024853	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962653980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW SMILE CENTER

Provider Business Mailing Address
First Line	:	4635 W. 63RD STREET
Second Line	:	SUITE D
City	:	CHICAGO
State	:	IL
Zip	:	60629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4635 W. 63RD STREET
Second Line	:	SUITE D
City	:	CHICAGO
State	:	IL
Zip	:	60629
Country	:	US
Telephone Number	:	773-735-7730
Fax Number	:

Authorized Official
Title or Position	:	DDS GENERAL DENTIST
Name	:	LINA POSKUS
Credential	:	DDS
Telephone Number	:	773-735-7730

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/15/2008

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Directions to “NEW SMILE CENTER ” Practice Location

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