Provider Demographics
NPI:1578862561
Name:C U SMILE,LLC
Entity Type:Organization
Organization Name:C U SMILE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NUSRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-531-1852
Mailing Address - Street 1:4906 PEIFER LN
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-8321
Mailing Address - Country:US
Mailing Address - Phone:217-531-1852
Mailing Address - Fax:217-531-1853
Practice Address - Street 1:4906 PEIFER LN
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-8321
Practice Address - Country:US
Practice Address - Phone:217-531-1852
Practice Address - Fax:217-531-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025812261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6889Medicaid