Healthcare Provider Details

I. General information

NPI: 1386077741
Provider Name (Legal Business Name): JAY SWEIS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2937 ILLINOIS 178
NORTH UTICA IL
61373
US

IV. Provider business mailing address

2715 N CENTRAL AVE STE 2A
CHICAGO IL
60639-1351
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: DENTIST
Credential: D.D.S.
Phone: 773-844-5283