Healthcare Provider Details

I. General information

NPI: 1386075067
Provider Name (Legal Business Name): EVERYONE'S FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2937 ILLINOIS 178
NORTH UTICA IL
61373
US

IV. Provider business mailing address

2937 ILLINOIS 178
NORTH UTICA IL
61373
US

V. Phone/Fax

Practice location:
  • Phone: 815-993-3101
  • Fax:
Mailing address:
  • Phone:
  • 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
Credential: D.D.S.
Phone: 815-993-3101