Provider Demographics
NPI:1669656195
Name:SMITH & SMITH SMILE STUDIO, PC
Entity Type:Organization
Organization Name:SMITH & SMITH SMILE STUDIO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-899-4174
Mailing Address - Street 1:1457 E HYDE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3037
Mailing Address - Country:US
Mailing Address - Phone:773-493-1663
Mailing Address - Fax:
Practice Address - Street 1:1457 E HYDE PARK BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-3037
Practice Address - Country:US
Practice Address - Phone:773-493-1663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty