Provider Demographics
NPI:1770968125
Name:SMILES OF HOPE INCORPORATED
Entity type:Organization
Organization Name:SMILES OF HOPE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ZIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-935-4507
Mailing Address - Street 1:3218 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3003
Mailing Address - Country:US
Mailing Address - Phone:630-935-4507
Mailing Address - Fax:
Practice Address - Street 1:3218 KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3003
Practice Address - Country:US
Practice Address - Phone:630-935-4507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019096261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental