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General NPI Number Information
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NPI Number | 1235300849
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Entity Type | Organization
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Legal Business Name | CELEBRITYSMILES
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Dates
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Enumeration Date | 03/23/2008
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Last Update Date | 03/23/2008
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Provider Practice Location Address
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Address Line | 3208 N SOUTHPORT AVE
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City | CHICAGO
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State | IL
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Zip | 60657-3204
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Country | US
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Telephone | 773-883-1557
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Fax |
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Provider Business Mailing Address
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Address Line | 3208 N SOUTHPORT AVE
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City | CHICAGO
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State | IL
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Zip | 60657-3204
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Country | US
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Telephone | 773-883-1557
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | JET CHIRANAND
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Credential | D.D.S.
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Telephone | 773-883-1557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | IL
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