Provider Demographics
NPI:1316131311
Name:SMILE SUPPORT LTD
Entity type:Organization
Organization Name:SMILE SUPPORT LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-412-0094
Mailing Address - Street 1:1507 E 53RD ST
Mailing Address - Street 2:UNIT 166
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4509
Mailing Address - Country:US
Mailing Address - Phone:773-412-0094
Mailing Address - Fax:
Practice Address - Street 1:1507 E 53RD ST
Practice Address - Street 2:UNIT 166
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4509
Practice Address - Country:US
Practice Address - Phone:773-412-0094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-01
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty