Provider Demographics
NPI:1780020461
Name:KIMBERLY SMILES
Entity Type:Organization
Organization Name:KIMBERLY SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-276-1047
Mailing Address - Street 1:1835 N MILWAUKEE AVE
Mailing Address - Street 2:CW
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6186
Mailing Address - Country:US
Mailing Address - Phone:773-276-1047
Mailing Address - Fax:
Practice Address - Street 1:1835 N MILWAUKEE AVE
Practice Address - Street 2:CW
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6186
Practice Address - Country:US
Practice Address - Phone:773-276-1047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty