Healthcare Provider Details

I. General information

NPI: 1235557109
Provider Name (Legal Business Name): EVERYONE'S FAMILY DENTAL ST. CHARLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 VISA DR UNIT #3
NORMAL IL
61761-2195
US

IV. Provider business mailing address

1400 LINCOLN HWY UNIT B
ST CHARLES IL
60174-3580
US

V. Phone/Fax

Practice location:
  • Phone: 773-844-5283
  • Fax:
Mailing address:
  • Phone: 773-844-5283
  • 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: OWNER
Credential: DDS
Phone: 773-844-5283