1396469425 NPI number — SMILES4U

Table of content: ELIZABETH JUNE DIXON LCSW (NPI 1205071446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396469425 NPI number — SMILES4U

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMILES4U
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396469425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001. E. MAIN ST SUITE F
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
ST. CHARLES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-513-5500
Provider Business Mailing Address Fax Number:
630-513-5501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001. E. MAIN ST
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
ST. CHARLES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-513-5500
Provider Business Practice Location Address Fax Number:
630-513-5501
Provider Enumeration Date:
10/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
ZAIDI
Authorized Official First Name:
TABASSUM
Authorized Official Middle Name:
TOUQIR
Authorized Official Title or Position:
OWNER (DENTIST)
Authorized Official Telephone Number:
630-513-5500

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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