Provider Demographics
NPI:1184163495
Name:SMILE CLINIQUE, PC
Entity type:Organization
Organization Name:SMILE CLINIQUE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RITU
Authorized Official - Middle Name:
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-548-9527
Mailing Address - Street 1:2213 N IL ROUTE 83
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4907
Mailing Address - Country:US
Mailing Address - Phone:847-548-9527
Mailing Address - Fax:847-548-9637
Practice Address - Street 1:2213 N IL ROUTE 83
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-4907
Practice Address - Country:US
Practice Address - Phone:847-548-9527
Practice Address - Fax:847-548-9637
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
IL19025953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty