Provider Demographics
NPI:1013647445
Name:MY SMILES DENTAL CENTER CRESCENT INC.
Entity Type:Organization
Organization Name:MY SMILES DENTAL CENTER CRESCENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HIDAYATHULLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:224-766-9876
Mailing Address - Street 1:307 S MILWAUKEE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5035
Mailing Address - Country:US
Mailing Address - Phone:847-306-5574
Mailing Address - Fax:847-789-7193
Practice Address - Street 1:307 S MILWAUKEE AVE STE 101
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5035
Practice Address - Country:US
Practice Address - Phone:847-306-5574
Practice Address - Fax:847-789-7193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental