Provider Demographics
NPI:1922153659
Name:SMILE DENTAL WORKS LTD
Entity Type:Organization
Organization Name:SMILE DENTAL WORKS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:VILLAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-310-0022
Mailing Address - Street 1:1222 N ROSELLE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3642
Mailing Address - Country:US
Mailing Address - Phone:847-310-0022
Mailing Address - Fax:847-310-8497
Practice Address - Street 1:1222 N ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3642
Practice Address - Country:US
Practice Address - Phone:847-310-0022
Practice Address - Fax:847-310-8497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190236131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9185883Medicaid