Healthcare Provider Details

I. General information

NPI: 1720385594
Provider Name (Legal Business Name): GLOBAL SMILES DENTAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S CALIFORNIA AVE SUITE 101
CHICAGO IL
60608-2486
US

IV. Provider business mailing address

608 N MAY ST #4
CHICAGO IL
60642-5829
US

V. Phone/Fax

Practice location:
  • Phone: 773-484-1201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019028282
License Number StateIL

VIII. Authorized Official

Name: DR. JEFFERY J KORKUS III
Title or Position: OWNER
Credential: D.D.S.
Phone: 312-860-4001