Provider Demographics
NPI:1154822526
Name:ORTHO2SMILE
Entity Type:Organization
Organization Name:ORTHO2SMILE
Other - Org Name:PREMIER ORTHODONTICS & DENTAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-279-5345
Mailing Address - Street 1:501 S YORK ST STE A
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3966
Mailing Address - Country:US
Mailing Address - Phone:630-279-5345
Mailing Address - Fax:
Practice Address - Street 1:501 S YORK ST STE A
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3966
Practice Address - Country:US
Practice Address - Phone:630-279-5345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty