Provider Demographics
NPI:1619613775
Name:SIGNATURE SMILE ARTS, PC
Entity Type:Organization
Organization Name:SIGNATURE SMILE ARTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-799-5353
Mailing Address - Street 1:1001 S STATE ST UNIT 1401
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2231
Mailing Address - Country:US
Mailing Address - Phone:248-345-3521
Mailing Address - Fax:
Practice Address - Street 1:18114 GOTTSCHALK AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2208
Practice Address - Country:US
Practice Address - Phone:708-799-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty