Provider Demographics
NPI:1508076274
Name:FAMILY SMILES P.C.
Entity Type:Organization
Organization Name:FAMILY SMILES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMATOLLAHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-866-0041
Mailing Address - Street 1:5240 N PULASKI RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1750
Mailing Address - Country:US
Mailing Address - Phone:773-866-0041
Mailing Address - Fax:773-866-0045
Practice Address - Street 1:5240 N PULASKI RD
Practice Address - Street 2:SUITE I
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1750
Practice Address - Country:US
Practice Address - Phone:773-866-0041
Practice Address - Fax:773-866-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty