Healthcare Provider Details

I. General information

NPI: 1659790855
Provider Name (Legal Business Name): JAY SWEIS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6027 W BELMONT AVE
CHICAGO IL
60634-5116
US

IV. Provider business mailing address

6027 W BELMONT AVE
CHICAGO IL
60634-5116
US

V. Phone/Fax

Practice location:
  • Phone: 773-887-3397
  • Fax:
Mailing address:
  • Phone: 773-887-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019028603
License Number StateIL

VIII. Authorized Official

Name: DR. JUBRAIL SWEIS
Title or Position: DENTIST/OWNER
Credential: D.D.S
Phone: 773-844-5283