Provider Demographics
NPI:1760779532
Name:WHITE SMILE, INC
Entity Type:Organization
Organization Name:WHITE SMILE, INC
Other - Org Name:BELVIDERE DENTAL DESIGNS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HIMANSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-544-2626
Mailing Address - Street 1:121 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-3628
Mailing Address - Country:US
Mailing Address - Phone:815-544-2626
Mailing Address - Fax:
Practice Address - Street 1:121 S STATE ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3628
Practice Address - Country:US
Practice Address - Phone:815-544-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026435305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization