NPIMap

Organization Active NPI

Smiles of Northlake Corp

  • General Practice Dentistry
  • Northlake, IL
National Provider Identifier
1265102487
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SMILES OF NORTHLAKE CORP
Practice address
32 E North Ave
Northlake, IL 60164-2500
Phone
(732) 325-4395
NPI assigned
Sep 18, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mansi Mehta, DDSNPI 1194131789
Title
President
Phone
(732) 325-4395

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

32 E North Ave
Northlake, IL 60164-2500

Mailing address

32 E North Ave
Northlake, IL 60164-2500
Phone (708) 562-1105

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL www.smilesofnorthlake.com

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1265102487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 E NORTH AVE",
            "city": "NORTHLAKE",
            "state": "IL",
            "postal_code": "601642500",
            "telephone_number": "708-562-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 E NORTH AVE",
            "city": "NORTHLAKE",
            "state": "IL",
            "postal_code": "601642500",
            "telephone_number": "732-325-4395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILES OF NORTHLAKE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-18",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A",
        "authorized_official_last_name": "MEHTA",
        "authorized_official_first_name": "MANSI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-325-4395",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.smilesofnorthlake.com",
            "affiliation": "N",
            "address_1": "32 E North Ave",
            "city": "Northlake",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601642500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Northlake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.