Provider Demographics
NPI:1700136611
Name:PINEHURST SMILE CENTER LTD.
Entity Type:Organization
Organization Name:PINEHURST SMILE CENTER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:VIHNANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-656-4008
Mailing Address - Street 1:2182 LAKE COOK ROAD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102
Mailing Address - Country:US
Mailing Address - Phone:312-656-4008
Mailing Address - Fax:630-238-1509
Practice Address - Street 1:2182 LAKE COOK ROAD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102
Practice Address - Country:US
Practice Address - Phone:312-656-4008
Practice Address - Fax:630-238-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty