Provider Demographics
NPI:1336668359
Name:CENTER FOR SMILES
Entity Type:Organization
Organization Name:CENTER FOR SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:LILY
Authorized Official - Last Name:GULIANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-527-9141
Mailing Address - Street 1:6618 N KILPATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3308
Mailing Address - Country:US
Mailing Address - Phone:773-527-9141
Mailing Address - Fax:
Practice Address - Street 1:7366 N LINCOLN AVE STE 103
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1738
Practice Address - Country:US
Practice Address - Phone:773-527-9141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031094261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental