Provider Demographics
NPI:1699598011
Name:GROWING SMILES, PC
Entity type:Organization
Organization Name:GROWING SMILES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-399-8749
Mailing Address - Street 1:3701 N SOUTHPORT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4360
Mailing Address - Country:US
Mailing Address - Phone:773-472-4769
Mailing Address - Fax:773-472-4777
Practice Address - Street 1:3701 N SOUTHPORT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4360
Practice Address - Country:US
Practice Address - Phone:773-472-4769
Practice Address - Fax:773-472-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1053490383OtherNPPES
IA1053801209OtherNPPES
IL1578149514OtherNPPES