Provider Demographics
NPI:1922547264
Name:SHINING SMILES 4, INC
Entity Type:Organization
Organization Name:SHINING SMILES 4, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURAHMADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-217-2223
Mailing Address - Street 1:210 N BOLINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2386
Mailing Address - Country:US
Mailing Address - Phone:815-310-3220
Mailing Address - Fax:
Practice Address - Street 1:110 N LARKIN AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6603
Practice Address - Country:US
Practice Address - Phone:630-972-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190281151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty