Provider Demographics
NPI:1790286169
Name:ORTHO2SMILE
Entity Type:Organization
Organization Name:ORTHO2SMILE
Other - Org Name:PREMIER ORTHODONTICS & DENTAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-964-0115
Mailing Address - Street 1:4326 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2875
Mailing Address - Country:US
Mailing Address - Phone:630-964-0115
Mailing Address - Fax:
Practice Address - Street 1:4326 PRINCE ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2875
Practice Address - Country:US
Practice Address - Phone:630-964-0115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty