Healthcare Provider Details

I. General information

NPI: 1649323239
Provider Name (Legal Business Name): HEALTHY SMILES DENTAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 E IRVING PARK RD
STREAMWOOD IL
60107-3100
US

IV. Provider business mailing address

906 E IRVING PARK RD
STREAMWOOD IL
60107-3100
US

V. Phone/Fax

Practice location:
  • Phone: 630-837-5500
  • Fax:
Mailing address:
  • Phone: 630-837-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: DR. GIUSTO ROMANO
Title or Position: OWNER
Credential: D.D.S.
Phone: 630-837-5500