Provider Demographics
NPI:1609100775
Name:SMILE CREATIONS
Entity Type:Organization
Organization Name:SMILE CREATIONS
Other - Org Name:SMILE CREATIONS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAYUN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-687-2974
Mailing Address - Street 1:1100 NERGE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3259
Mailing Address - Country:US
Mailing Address - Phone:847-891-6600
Mailing Address - Fax:
Practice Address - Street 1:1100 NERGE RD STE 209
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3259
Practice Address - Country:US
Practice Address - Phone:847-891-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-026102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty