Provider Demographics
NPI:1528231404
Name:YOUR SMILE BY DESIGN, P.C.
Entity Type:Organization
Organization Name:YOUR SMILE BY DESIGN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:INGALLINERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-327-6692
Mailing Address - Street 1:1635 W BELMONT AVE
Mailing Address - Street 2:UNIT 708
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3047
Mailing Address - Country:US
Mailing Address - Phone:773-327-6692
Mailing Address - Fax:
Practice Address - Street 1:3939 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2243
Practice Address - Country:US
Practice Address - Phone:773-235-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025292251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004771Medicaid