7011 W Archer Ave
Dentist, General Practice in Chicago, IL. Organization (NPI-2).
NPI number1750686820
StatusActive
Last updated in NPPESJan 20, 2011
Details
- NPI
- 1750686820
- Entity type
- Organization (NPI-2)
- Legal business name
- 7011 W Archer Ave
- Organization subpart
- No
- Enumeration date
- Jan 20, 2011
- Last updated
- Jan 20, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 019025135 | IL | Yes |
| 1223G0001X | Dentist, General Practice | 019027403 | IL | |
| 1223G0001X | Dentist, General Practice | 019025077 | IL |
Other names
- Smile Dental Care (Doing Business As)
Practice location
7011 W Archer AveChicago, IL 60638-2201
Phone 773-788-9090
Mailing address
7011 W Archer AveChicago, IL 60638-2201
Phone 773-788-9090
Authorized official
Khalil Takla
Owner/Dentist
7083648900
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