Provider Demographics
NPI:1396159794
Name:SMILE SOLUTIONS OF CLARENDON HILLS, LLC
Entity type:Organization
Organization Name:SMILE SOLUTIONS OF CLARENDON HILLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:COGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-325-9298
Mailing Address - Street 1:235 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1148
Mailing Address - Country:US
Mailing Address - Phone:630-325-9298
Mailing Address - Fax:630-325-9299
Practice Address - Street 1:235 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1148
Practice Address - Country:US
Practice Address - Phone:630-325-9298
Practice Address - Fax:630-325-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty