1811165046 NPI number — ALL SMILES ORTHODONTICS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811165046 NPI number — ALL SMILES ORTHODONTICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL SMILES ORTHODONTICS, INC
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:
1811165046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19710 GOVERNORS HWY
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
FLOSSMOOR
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60422-2080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-799-6200
Provider Business Mailing Address Fax Number:
708-799-9397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19710 GOVERNORS HWY
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
FLOSSMOOR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60422-2080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-799-6200
Provider Business Practice Location Address Fax Number:
708-799-9397
Provider Enumeration Date:
02/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AKHRAS
Authorized Official First Name:
FADI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-799-6200

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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