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General NPI Number Information
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NPI Number | 1275142382
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Entity Type | Organization
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Legal Business Name | DENTAL SMILES OF JOLIET
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 2410 W JEFFERSON ST STE 108
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City | JOLIET
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State | IL
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Zip | 60435-6451
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Country | US
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Telephone | 213-820-6484
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Fax |
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Provider Business Mailing Address
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Address Line | 2271 SABLE OAKS DR
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City | NAPERVILLE
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State | IL
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Zip | 60564-5665
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Country | US
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Telephone | 213-820-6487
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALI KHAN
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Credential | DDS
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Telephone | 213-820-6487
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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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