Provider Demographics
NPI:1063785806
Name:SHINY SMILES INC
Entity type:Organization
Organization Name:SHINY SMILES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURAHMADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-217-2223
Mailing Address - Street 1:3332 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6213
Mailing Address - Country:US
Mailing Address - Phone:312-217-2223
Mailing Address - Fax:
Practice Address - Street 1:3332 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6213
Practice Address - Country:US
Practice Address - Phone:312-217-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty