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General NPI Number Information
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NPI Number | 1215338793
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Entity Type | Organization
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Legal Business Name | ALL SMILES DENTAL CENTER
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 5240 N PULASKI RD SUITE I
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City | CHICAGO
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State | IL
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Zip | 60630-1750
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Country | US
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Telephone | 312-623-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 5240 N PULASKI RD SUITE I
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City | CHICAGO
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State | IL
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Zip | 60630-1750
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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. HUI JUN PARK
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Credential | DDS
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Telephone | 312-623-6888
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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 | 019-025067
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License Number State | IL
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