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General NPI Number Information
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NPI Number | 1104732684
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Entity Type | Organization
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Legal Business Name | CRYSTAL SMILES DENTAL
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 8917 W CERMAK RD
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1163
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Country | US
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Telephone | 708-442-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 8917 W CERMAK RD
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1163
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SIMON A TADROS
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Credential | DMD
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Telephone | 708-307-4908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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