Provider Demographics
NPI:1346634656
Name:SMILEDENTIST, PC
Entity Type:Organization
Organization Name:SMILEDENTIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG
Authorized Official - Middle Name:UK
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-547-7300
Mailing Address - Street 1:303 ANDREWS DRIVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008
Mailing Address - Country:US
Mailing Address - Phone:815-547-7300
Mailing Address - Fax:815-547-7308
Practice Address - Street 1:303 ANDREWS DR
Practice Address - Street 2:SUITE 301
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3918
Practice Address - Country:US
Practice Address - Phone:815-547-7300
Practice Address - Fax:815-547-7308
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMILEDENTIST, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190216461223G0001X
IL0190265731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty