Provider Demographics
NPI:1568919025
Name:SCOTT G SMORON DDS MSD LTD
Entity Type:Organization
Organization Name:SCOTT G SMORON DDS MSD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR, OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMORON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:847-255-2526
Mailing Address - Street 1:421 W. PROSPECT AVE.
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-255-2526
Mailing Address - Fax:
Practice Address - Street 1:421 W. PROSPECT AVE.
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:847-255-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0020001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty