Provider Demographics
NPI:1093188930
Name:MONICA URDA DDS LLC
Entity Type:Organization
Organization Name:MONICA URDA DDS LLC
Other - Org Name:SMILE SCIENCE CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:URDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:224-577-9062
Mailing Address - Street 1:3520 N LAKE SHORE DR
Mailing Address - Street 2:UNIT 6G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1860
Mailing Address - Country:US
Mailing Address - Phone:224-577-9062
Mailing Address - Fax:
Practice Address - Street 1:1755 W NORTH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5450
Practice Address - Country:US
Practice Address - Phone:224-577-9062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-31
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319018676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty