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General NPI Number Information
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NPI Number | 1285768382
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Entity Type | Organization
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Legal Business Name | DRS TALBOT AND SMITH FAMILY DENTAL CARE
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 330 MADISON ST SUITE 304
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City | JOLIET
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State | IL
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Zip | 60435-6565
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Country | US
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Telephone | 815-725-2200
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Fax | 815-725-2533
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Provider Business Mailing Address
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Address Line | 330 MADISON ST SUITE 304
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City | JOLIET
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State | IL
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Zip | 60435-6565
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Country | US
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Telephone | 815-725-2200
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Fax | 815-725-2533
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Authorized Official
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Title or Position | PRES.
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Name | DR. PATRICK SMITH
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Credential | D.D.S
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Telephone | 815-725-2200
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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 | IL
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