Provider Demographics
NPI:1508037698
Name:HOUSE OS SMILES, PC
Entity Type:Organization
Organization Name:HOUSE OS SMILES, PC
Other - Org Name:IROQUOIS DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-416-0780
Mailing Address - Street 1:1163 E OGDEN AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1687
Mailing Address - Country:US
Mailing Address - Phone:630-416-0780
Mailing Address - Fax:630-416-6938
Practice Address - Street 1:1163 E OGDEN AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1687
Practice Address - Country:US
Practice Address - Phone:630-416-0780
Practice Address - Fax:630-416-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9179275Medicaid