Provider Demographics
NPI:1588304919
Name:SMILES ON ASHLAND DENTAL CO
Entity type:Organization
Organization Name:SMILES ON ASHLAND DENTAL CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIEN
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:708-752-6154
Mailing Address - Street 1:3555 N ASHLAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1361
Mailing Address - Country:US
Mailing Address - Phone:312-392-1929
Mailing Address - Fax:
Practice Address - Street 1:3555 N ASHLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1361
Practice Address - Country:US
Practice Address - Phone:312-392-1929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental