MEDICARE: CUTEST SMILE LTD.

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	122300000X	Dentist

General Provider Information

NPI Number	:	1619426491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUTEST SMILE LTD.

Provider Business Mailing Address
First Line	:	3224 W BRYN MAWR AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3606
Country	:	US
Telephone Number	:	815-608-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3224 W BRYN MAWR AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3606
Country	:	US
Telephone Number	:	815-608-0900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JONATHAN NABONG ABIERA
Credential	:	DMD
Telephone Number	:	815-608-0900

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	09/22/2016

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