Provider Demographics
NPI:1568537223
Name:SMILECHICAGO
Entity Type:Organization
Organization Name:SMILECHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-644-4321
Mailing Address - Street 1:400 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1014
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4104
Mailing Address - Country:US
Mailing Address - Phone:312-644-4321
Mailing Address - Fax:312-644-4325
Practice Address - Street 1:400 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1014
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4104
Practice Address - Country:US
Practice Address - Phone:312-644-4321
Practice Address - Fax:312-644-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19164291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty