Healthcare Provider Details

I. General information

NPI: 1740691468
Provider Name (Legal Business Name): JAY SWEIS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1400 LINCOLN HWY SUITE 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: JUBRAIL SWEIS
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 773-844-5283