Provider Demographics
NPI:1689776429
Name:SMILE DENTAL CARE
Entity Type:Organization
Organization Name:SMILE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-620-4364
Mailing Address - Street 1:837 WESTMORE MEYERS RD
Mailing Address - Street 2:SUITE B29-30
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3724
Mailing Address - Country:US
Mailing Address - Phone:630-620-4364
Mailing Address - Fax:630-620-1779
Practice Address - Street 1:837 WESTMORE MEYERS RD
Practice Address - Street 2:SUITE B29-30
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3724
Practice Address - Country:US
Practice Address - Phone:630-620-4364
Practice Address - Fax:630-620-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization