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General NPI Number Information
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NPI Number | 1356417240
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Entity Type | Organization
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Legal Business Name | SPARKLING DENTAL CARE P.C.
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 401 E NORTH AVE SUITE 9
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City | VILLA PARK
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State | IL
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Zip | 60181-1218
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Country | US
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Telephone | 630-530-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 566 N ELLSWORTH AVE
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City | ADDISON
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State | IL
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Zip | 60101-2917
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Country | US
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Telephone | 630-279-9000
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Fax |
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Authorized Official
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Title or Position | PRES OWNER
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Name | MICHAEL JOSEPH LEBIECKI
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Credential | DMD DDS
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Telephone | 630-530-4949
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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 | 019022734
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License Number State | IL
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