NPIMap

Organization Active NPI

Shining Smiles 4, Inc

  • General Practice Dentistry
  • Joliet, IL
National Provider Identifier
1922547264
Registry record updated Feb 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019028115 Issued in IL
Legal business name
SHINING SMILES 4, INC
Practice address
110 N Larkin Ave
Joliet, IL 60435-6603
Phone
(630) 972-4010
NPI assigned
Feb 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2017

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

Authorized official

Name
Dr. Milad Nourahmadi, DDS
Title
Secretary
Phone
(312) 217-2223

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019028115 IL Primary

Addresses

Primary practice location

110 N Larkin Ave
Joliet, IL 60435-6603

Mailing address

210 N Bolingbrook Dr
Bolingbrook, IL 60440-2386
Phone (815) 310-3220

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1487548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1922547264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 N BOLINGBROOK DR",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402386",
            "telephone_number": "815-310-3220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N LARKIN AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604356603",
            "telephone_number": "630-972-4010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINING SMILES 4, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-20",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "NOURAHMADI",
        "authorized_official_first_name": "MILAD",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "312-217-2223",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019028115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; 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.