Provider Demographics
NPI:1164005740
Name:SMILE GROUP HIGHLAND PARK, PLLC
Entity Type:Organization
Organization Name:SMILE GROUP HIGHLAND PARK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGOIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-727-4077
Mailing Address - Street 1:1259 N WOOD ST APT 406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8800
Mailing Address - Country:US
Mailing Address - Phone:847-727-4077
Mailing Address - Fax:
Practice Address - Street 1:806 CENTRAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5613
Practice Address - Country:US
Practice Address - Phone:847-432-4131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental