=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558704577
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAY SWEIS D.D.S P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2013
-----------------------------------------------------
Last Update Date | 04/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2715 N CENTRAL AVE SUITE A
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60639-1351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-308-5542
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 727 RIDGEVIEW DR
-----------------------------------------------------
City | MCHENRY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60050-7054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-308-5542
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JUBRAIL SWEIS
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 773-308-5542
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 019028603
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------