Provider Demographics
NPI:1063079150
Name:SMILES OF CARPENTERSVILLE PLLC
Entity type:Organization
Organization Name:SMILES OF CARPENTERSVILLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:PALLAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-783-6544
Mailing Address - Street 1:27 S WESTERN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-1715
Mailing Address - Country:US
Mailing Address - Phone:224-805-0502
Mailing Address - Fax:847-783-6552
Practice Address - Street 1:27 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-1715
Practice Address - Country:US
Practice Address - Phone:224-805-0502
Practice Address - Fax:847-496-5057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty