Provider Demographics
NPI:1376976563
Name:SHINING SMILES PLAINFIELD INC
Entity Type:Organization
Organization Name:SHINING SMILES PLAINFIELD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURAHMADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-217-2223
Mailing Address - Street 1:616 W FULTON ST
Mailing Address - Street 2:UNIT 612
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13400 S ROUTE 59
Practice Address - Street 2:SUITE 104
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5826
Practice Address - Country:US
Practice Address - Phone:312-217-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190281151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty