Provider Demographics
NPI:1780345710
Name:NORTH SHORE SMILE STUDIO LLC
Entity type:Organization
Organization Name:NORTH SHORE SMILE STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANESZKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-787-2131
Mailing Address - Street 1:845 N MICHIGAN AVE STE 951W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2211
Mailing Address - Country:US
Mailing Address - Phone:312-787-2131
Mailing Address - Fax:
Practice Address - Street 1:845 N MICHIGAN AVE STE 951W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2211
Practice Address - Country:US
Practice Address - Phone:312-787-2131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1245363332OtherNPI
1861515595OtherNPI