Provider Demographics
NPI:1972224509
Name:VIVID SMILES CHICAGO
Entity type:Organization
Organization Name:VIVID SMILES CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:216-319-9451
Mailing Address - Street 1:2706 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1321
Mailing Address - Country:US
Mailing Address - Phone:773-250-7300
Mailing Address - Fax:
Practice Address - Street 1:2706 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1321
Practice Address - Country:US
Practice Address - Phone:773-250-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental