Provider Demographics
NPI:1447853700
Name:SMILES OF LINDENHURST
Entity type:Organization
Organization Name:SMILES OF LINDENHURST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GNIADEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-265-9070
Mailing Address - Street 1:2031 E GRAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9094
Mailing Address - Country:US
Mailing Address - Phone:847-265-9070
Mailing Address - Fax:847-265-9279
Practice Address - Street 1:2031 E GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-9094
Practice Address - Country:US
Practice Address - Phone:847-265-9070
Practice Address - Fax:847-265-9279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty