Healthcare Provider Details

I. General information

NPI: 1306483433
Provider Name (Legal Business Name): JUST SMILES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 S 17TH AVE
BROADVIEW IL
60155-3019
US

IV. Provider business mailing address

2133 S 17TH AVE
BROADVIEW IL
60155-3019
US

V. Phone/Fax

Practice location:
  • Phone: 708-865-0200
  • Fax: 708-865-1730
Mailing address:
  • Phone: 708-865-0200
  • Fax: 708-865-1730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMIKA WESLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-865-0200