Provider Demographics
NPI:1003622168
Name:SMILE SOCIETY ORTHODONTICS
Entity type:Organization
Organization Name:SMILE SOCIETY ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIM
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:TARAJI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:224-544-0249
Mailing Address - Street 1:222 N COLUMBUS DR APT 3909
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7824
Mailing Address - Country:US
Mailing Address - Phone:224-544-0249
Mailing Address - Fax:
Practice Address - Street 1:1328 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-9148
Practice Address - Country:US
Practice Address - Phone:303-718-1853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty