Provider Demographics
NPI:1467822684
Name:SMART SMILES DENTAL, LLC
Entity Type:Organization
Organization Name:SMART SMILES DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASIMIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-922-3411
Mailing Address - Street 1:850 S. WABASH
Mailing Address - Street 2:SUITE #250
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605
Mailing Address - Country:US
Mailing Address - Phone:312-922-3411
Mailing Address - Fax:
Practice Address - Street 1:850 S WABASH AVE
Practice Address - Street 2:SUITE #250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3641
Practice Address - Country:US
Practice Address - Phone:312-922-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026337261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019026337Medicaid