Provider Demographics
NPI:1659038321
Name:SMILE DIAGNOSTIC SERVICES INC
Entity Type:Organization
Organization Name:SMILE DIAGNOSTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JALALUDDIN
Authorized Official - Middle Name:FAWAD
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-641-1983
Mailing Address - Street 1:9028 FEDERAL CT APT 1A
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-7014
Mailing Address - Country:US
Mailing Address - Phone:646-641-1983
Mailing Address - Fax:
Practice Address - Street 1:9028 FEDERAL CT APT 1A
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-7014
Practice Address - Country:US
Practice Address - Phone:646-641-1983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile