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Organization
SMILE LINE DENTAL LLC
Active
Organization
SMILE LINE DENTAL LLC
Active
Other names
Hicks Family Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUMRANA S AHMED DDS (MEMBER)
(847) 359-9100
Entity
Organization
Contact information
Practice address
2381 N HICKS RD, PALATINE, IL 60074-1806
(847) 359-9100
(630) 477-0447
Mailing address
2381 N HICKS RD, PALATINE, IL 60074-1806
(847) 359-9100
(630) 477-0447
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019026293
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1005798
—
IL
Enumeration date
03/09/2010
Last updated
03/09/2010
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