Provider Demographics
NPI:1083885271
Name:PERFECT SMILE P.C.
Entity Type:Organization
Organization Name:PERFECT SMILE P.C.
Other - Org Name:MONTROSE ASHLAND DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SALMAN
Authorized Official - Middle Name:UMAR
Authorized Official - Last Name:POOTHAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-275-5600
Mailing Address - Street 1:1624 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1214
Mailing Address - Country:US
Mailing Address - Phone:773-275-5600
Mailing Address - Fax:773-275-5868
Practice Address - Street 1:1624 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1214
Practice Address - Country:US
Practice Address - Phone:773-275-5600
Practice Address - Fax:773-275-5868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190263291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty