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General NPI Number Information
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NPI Number | 1477985349
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Entity Type | Organization
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Legal Business Name | F&J TAN, LLC D/B/A SMILES ON CASS
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Dates
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Enumeration Date | 08/02/2013
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Last Update Date | 07/13/2015
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Provider Practice Location Address
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Address Line | 7339 CASS AVE
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City | DARIEN
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State | IL
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Zip | 60561-3660
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Country | US
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Telephone | 331-481-9302
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Fax |
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Provider Business Mailing Address
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Address Line | 7339 S. CASS AVE
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City | DARIEN
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State | IL
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Zip | 60561-1501
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Country | US
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Telephone | 331-481-9302
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | DR. JENNIFER S TAN
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Credential | DDS
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Telephone | 630-605-0837
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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 |
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