Provider Demographics
NPI:1275843799
Name:SMART DENTAL DESIGNERS
Entity Type:Organization
Organization Name:SMART DENTAL DESIGNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:GULLERMO
Authorized Official - Last Name:LOPERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-672-4201
Mailing Address - Street 1:693 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-3658
Mailing Address - Country:US
Mailing Address - Phone:847-672-4201
Mailing Address - Fax:847-672-4208
Practice Address - Street 1:693 S LAKE ST
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-3658
Practice Address - Country:US
Practice Address - Phone:847-672-4201
Practice Address - Fax:847-672-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026862261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental