Provider Demographics
NPI:1760727796
Name:MILLENNIUM PARK SMILES, LLC
Entity Type:Organization
Organization Name:MILLENNIUM PARK SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BABOULAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-263-7200
Mailing Address - Street 1:25 E WASHINGTON ST
Mailing Address - Street 2:SUITE 1707
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:312-263-7200
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON
Practice Address - Street 2:SUITE 1707
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-263-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190204531223G0001X
IL0190201541223G0001X
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty