The Smile Group LLC

Primary specialty

DentistTaxonomy code 122300000X

License

019.028496 Issued in IL

Legal business name

THE SMILE GROUP LLC

Practice address

111 N Wabash Ave
Suite 1412
Chicago, IL 60602-1903

Phone

(309) 282-8565

Fax

(309) 265-0156

NPI assigned

Dec 18, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Robert Owen Wolf, DDS

Title

Owner

Phone

(216) 973-0552

Specialties & licenses 1

Addresses

Other names 1

• Koala Center for Sleep Disorders Doing business as

Locations

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

{
    "created_epoch": "1387324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387324800000",
    "number": "1942621925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11825 STATE ROUTE 40",
            "address_2": "SUITE 100",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "615258842",
            "telephone_number": "309-282-8565",
            "fax_number": "309-265-0156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N WABASH AVE",
            "address_2": "SUITE 1412",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606021903",
            "telephone_number": "309-282-8565",
            "fax_number": "309-265-0156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SMILE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-18",
        "last_updated": "2013-12-18",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "OWEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "216-973-0552",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.028496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Koala Center for Sleep Disorders",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; 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.