Provider Demographics
NPI:1679010318
Name:SMILE DESIGN DENTAL
Entity Type:Organization
Organization Name:SMILE DESIGN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-202-9955
Mailing Address - Street 1:6278 N CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4918
Mailing Address - Country:US
Mailing Address - Phone:773-202-9955
Mailing Address - Fax:773-202-9957
Practice Address - Street 1:6278 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4918
Practice Address - Country:US
Practice Address - Phone:773-202-9955
Practice Address - Fax:773-202-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025729261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center