NPIMap

Organization Active NPI

Great Smile Dental PLLC

  • Dental Clinic/Center
  • Deerfield, IL
National Provider Identifier
1780290676
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
GREAT SMILE DENTAL PLLC
Doing business as
Great Smile Dental PLLC
Practice address
720 Osterman Ave Ste 304
Deerfield, IL 60015-4339
Phone
(847) 945-1050
Fax
(847) 940-0433
NPI assigned
Sep 16, 2020
Organization subpart
Yes
Parent organization
GREAT SMILE DENTAL PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Authorized official

Name
Jacqueline Morales
Title
District Manager
Phone
(847) 945-1050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

720 Osterman Ave Ste 304
Deerfield, IL 60015-4339

Mailing address

720 Osterman Ave Ste 304
Deerfield, IL 60015-4339
Phone (847) 945-1050

Other names 1

  • Great Smile Dental PLLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Great Smile Dental PLLC3 organizations share this tax ID, including this one
Part of
Great Smile Dental PLLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1780290676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 OSTERMAN AVE STE 304",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600154339",
            "telephone_number": "847-945-1050",
            "fax_number": "847-940-0433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 OSTERMAN AVE STE 304",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600154339",
            "telephone_number": "847-945-1050",
            "fax_number": "847-940-0433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT SMILE DENTAL PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT SMILE DENTAL PLLC",
        "enumeration_date": "2020-09-16",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "MORALES",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "DISTRICT MANAGER",
        "authorized_official_telephone_number": "847-945-1050"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Smile Dental PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deerfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; 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.