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General NPI Number Information
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NPI Number | 1013627322
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Entity Type | Organization
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Legal Business Name | SAUGANASH SMILES PC
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 6019 N CICERO AVE
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City | CHICAGO
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State | IL
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Zip | 60646-4301
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Country | US
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Telephone | 773-877-3133
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Fax | 773-877-3119
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Provider Business Mailing Address
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Address Line | 5911 N KEATING AVE
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City | CHICAGO
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State | IL
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Zip | 60646-5702
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Country | US
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Telephone | 847-345-1999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DALIA MAROUF
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Credential |
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Telephone | 773-877-3133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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