Provider Demographics
NPI:1861213985
Name:REGEN SMILE STUDIO, PLLC
Entity type:Organization
Organization Name:REGEN SMILE STUDIO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-971-0364
Mailing Address - Street 1:2915 W BELMONT AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-9770
Mailing Address - Country:US
Mailing Address - Phone:847-971-0364
Mailing Address - Fax:
Practice Address - Street 1:3208 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1106
Practice Address - Country:US
Practice Address - Phone:847-971-0364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental