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General NPI Number Information
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NPI Number | 1215369046
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Entity Type | Organization
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Legal Business Name | SMILE MORE DENTAL II CORP
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Dates
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Enumeration Date | 08/02/2013
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Last Update Date | 08/02/2013
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Provider Practice Location Address
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Address Line | 225 RICE LAKE SQ
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City | WHEATON
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State | IL
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Zip | 60189-2136
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Country | US
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Telephone | 630-954-7307
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Fax |
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Provider Business Mailing Address
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Address Line | 225 RICE LAKE SQ
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City | WHEATON
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State | IL
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Zip | 60189-2136
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Country | US
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Telephone | 630-954-7307
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | SAMI M DIAB
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Credential | DDS
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Telephone | 312-451-7264
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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 | 019027963
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License Number State | IL
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