Provider Demographics
NPI:1578810941
Name:CITYWIDE SMILES, P.C.
Entity Type:Organization
Organization Name:CITYWIDE SMILES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SMYTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-276-8409
Mailing Address - Street 1:34779 N LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1112
Mailing Address - Country:US
Mailing Address - Phone:847-276-8409
Mailing Address - Fax:
Practice Address - Street 1:34779 N LINDEN AVE
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1112
Practice Address - Country:US
Practice Address - Phone:847-276-8409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-05
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020335261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental