1376911164 NPI number — SMILES OF AURORA.

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 1376911164 NPI number — SMILES OF AURORA.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMILES OF AURORA.
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:
1376911164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 N CONSTITUTION DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-844-2640
Provider Business Mailing Address Fax Number:
630-844-2899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N. CONSTITUTION DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-844-2640
Provider Business Practice Location Address Fax Number:
630-844-2899
Provider Enumeration Date:
09/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GOETZ
Authorized Official First Name:
DUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
630-844-2640

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , 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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