Provider Demographics
NPI:1578076352
Name:CHICAGO STYLE SMILES, LLC
Entity Type:Organization
Organization Name:CHICAGO STYLE SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-372-4845
Mailing Address - Street 1:30 N MICHIGAN AVE STE 1506
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3689
Mailing Address - Country:US
Mailing Address - Phone:312-372-4845
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 1506
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3689
Practice Address - Country:US
Practice Address - Phone:312-372-4845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190287501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1013205103OtherKEVIN D DOW
IL1548472285OtherJAMES D ROHAN