Healthcare Provider Details

I. General information

NPI: 1104491604
Provider Name (Legal Business Name): ISMILE CHICAGO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4953 W FULLERTON AVE
CHICAGO IL
60639-2505
US

IV. Provider business mailing address

4953 W FULLERTON AVE
CHICAGO IL
60639-2505
US

V. Phone/Fax

Practice location:
  • Phone: 773-887-3244
  • Fax:
Mailing address:
  • Phone: 773-887-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

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