Healthcare Provider Details

I. General information

NPI: 1104732684
Provider Name (Legal Business Name): CRYSTAL SMILES DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8917 W CERMAK RD
NORTH RIVERSIDE IL
60546-1163
US

IV. Provider business mailing address

8917 W CERMAK RD
NORTH RIVERSIDE IL
60546-1163
US

V. Phone/Fax

Practice location:
  • Phone: 708-442-8787
  • Fax:
Mailing address:
  • Phone:
  • 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. SIMON A TADROS
Title or Position: OWNER
Credential: DMD
Phone: 708-307-4908