Provider Demographics
NPI:1043632623
Name:SPARKLING SMILES, PC
Entity Type:Organization
Organization Name:SPARKLING SMILES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-527-8992
Mailing Address - Street 1:903 S ASHLAND AVE
Mailing Address - Street 2:APT 1003
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4002
Mailing Address - Country:US
Mailing Address - Phone:708-527-8992
Mailing Address - Fax:
Practice Address - Street 1:903 S ASHLAND AVE
Practice Address - Street 2:APT 1003
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4002
Practice Address - Country:US
Practice Address - Phone:708-527-8992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty