Provider Demographics
NPI:1750929642
Name:ALL SMILES FAMILY DENTISTRY
Entity type:Organization
Organization Name:ALL SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHADA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:217-954-1244
Mailing Address - Street 1:2102 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1306
Mailing Address - Country:US
Mailing Address - Phone:217-954-1244
Mailing Address - Fax:217-803-2494
Practice Address - Street 1:2102 N MARKET ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1306
Practice Address - Country:US
Practice Address - Phone:217-954-1244
Practice Address - Fax:217-803-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental