MEDICARE: SAUGANASH SMILES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1013627322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAUGANASH SMILES PC

Provider Business Mailing Address
First Line	:	5911 N KEATING AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5702
Country	:	US
Telephone Number	:	847-345-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	6019 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4301
Country	:	US
Telephone Number	:	773-877-3133
Fax Number	:	773-877-3119

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DALIA MAROUF
Credential	:
Telephone Number	:	773-877-3133

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	11/28/2022

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