Provider Demographics
NPI:1265576466
Name:GREAT CHICAGO SMILES, P.C.
Entity type:Organization
Organization Name:GREAT CHICAGO SMILES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KROMASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-642-8830
Mailing Address - Street 1:737 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1305
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2615
Mailing Address - Country:US
Mailing Address - Phone:312-642-8830
Mailing Address - Fax:312-642-8784
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1305
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2615
Practice Address - Country:US
Practice Address - Phone:312-642-8830
Practice Address - Fax:312-642-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental