Provider Demographics
NPI:1306557483
Name:LINCOLN SMILES FAMILY DENTISTRY
Entity type:Organization
Organization Name:LINCOLN SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ODILIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NAVARRETE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-271-5200
Mailing Address - Street 1:5643 N FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4816
Mailing Address - Country:US
Mailing Address - Phone:773-271-5600
Mailing Address - Fax:773-271-3280
Practice Address - Street 1:5643 N FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4816
Practice Address - Country:US
Practice Address - Phone:773-271-5600
Practice Address - Fax:773-271-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental