MEDICARE: PERFECT SMILE DENTISTRY

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1538481270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFECT SMILE DENTISTRY

Provider Business Mailing Address
First Line	:	5748 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4726
Country	:	US
Telephone Number	:	847-791-5790
Fax Number	:

Provider Business Practice Location Address
First Line	:	5748 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4726
Country	:	US
Telephone Number	:	847-791-5790
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. TATYANA KHAIT
Credential	:	DDS
Telephone Number	:	847-791-5790

Provider Enumeration Date	:	02/22/2010
Last Update Date	:	02/22/2010

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