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General NPI Number Information
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NPI Number | 1386075067
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Entity Type | Organization
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Legal Business Name | EVERYONE'S FAMILY DENTAL
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Dates
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Enumeration Date | 12/06/2013
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 2937 ILLINOIS 178
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City | NORTH UTICA
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State | IL
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Zip | 61373
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Country | US
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Telephone | 815-993-3101
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Fax |
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Provider Business Mailing Address
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Address Line | 2937 ILLINOIS 178
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City | NORTH UTICA
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State | IL
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Zip | 61373
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JUBRAIL SWEIS
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Credential | D.D.S.
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Telephone | 815-993-3101
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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 | 019028603
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License Number State | IL
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